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Study: Checklists help surgical teams stay on point

Thursday January 17, 2013
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Surgical teams using checklists have markedly better performances during crises than others, with clinicians about 75% less likely to miss key life-saving steps in care, according to a study.

Failure to rescue surgical patients with life-threatening complications is the largest source of differences in rates of surgical death between hospitals, according to background information in the study, which appears in the Jan. 17 issue of the New England Journal of Medicine.

Researchers with Ariadne Labs, a joint center for health system innovation at Brigham and Womenís Hospital and Harvard School of Public Health, reported that the failure rate for performing life-saving processes of care dropped from 23% to 6% during simulations when checklists were available.

"For decades we in surgery have believed that surgical crisis situations are too complex for simple checklists to be helpful," Atul Gawande, MD, MPH, the studyís senior author and a surgeon at BWH, professor at HSPH and director of Ariadne Labs, said in a news release. "This work shows that assumption is wrong.

"Four years ago, we showed that completing a routine checklist before surgery can substantially reduce the likelihood of a major complication. This new work shows that use of a set of carefully crafted checklists during an operating room crisis also has the potential to markedly improve care and safety."

The researchers recruited 17 OR teams, comprised of nurses, anesthesia staff, surgical technologists and a mock surgeon participant to take part in 106 simulated surgical crises. Each team was randomized to manage half the scenarios with a set of crisis checklists and the remaining scenarios from memory alone.

The researchers found that in addition to reporting a reduction in failure to adhere to life-saving processes of care during simulations when checklists were available, 97% of participants said they would want these checklists used if they experienced an intraoperative crisis as a patient.

"Given these findings, Brigham and Womenís Hospital has now committed to implementing these checklists to increase the safety of our patients and to evaluate the effect they have on care," Gawande said. "I would encourage other hospitals and surgical centers to consider doing the same."

The researchers noted that because the study was performed in a simulated OR, whether adherence would improve in a real-world scenario is unclear. However, high-fidelity simulation has become increasingly accepted in medicine as a means of training and evaluation, and well-structured simulation testing has been shown to efficiently assess the value of safety protocols in other fields.

Up-to-date checklists and implementation materials can be found at www.projectcheck.org/crisis. The study abstract is available at www.nejm.org/doi/full/10.1056/NEJMsa1204720.


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