It’s too simple for a complex endeavor like surgery. Drastic drops in deaths and complications? Too good to be true.
Dr. Atul Gawande, a Brigham and Women's Hospital surgeon and evangelist of the aviation-inspired checklist for surgery, has heard it all before. He has preached adoption of a simple set of questions that should be asked before any surgical team starts an operation. When tested in a pilot program at eight hospitals around the world, from Seattle to Tanzania, it worked, cutting deaths and other serious problems almost in half.
Today he’s gratified to see a larger, more rigorous trial in the Netherlands deliver similar results. Writing in this week’s New England Journal of Medicine, Dutch authors say complications fell from 27 to 17 per 100 patients and deaths dropped from 1.5 to 0.7 percent at six high-standard hospitals after the checklist was used. They also compared results to six similar hospitals not using checklists at all.
“It’s huge,” Gawande said in an interview today. He was not involved with the Dutch study. “They independently validated the finding that safe surgical checklists can make a massive reduction in complications and deaths. Imagine a pill that could reduce surgical complications and deaths by more than a third. It would be a multibillion-dollar blockbuster.”
At the heart of a surgical checklist is the idea that no one person can hold in his or her head all the complexities involved in current medical care. A team can learn to share the knowledge of what needs to be done for an individual patient, which will also better prepare them for an unexpected crisis.
Checklists differ and need to be adapted to individual hospitals, but they commonly contain questions asked out loud about the purpose of the operation, what side it should be on, and whether there are special concerns team members have. Team members each say their names and why they are there.
“No matter how hard we work and how smart people are, we will have failures. And the evidence is, a team checklist can markedly reduce these failures,” Gawande said.
The routines stem from cockpit checklists and aviation safety work. Gawande says it never gets old for him, three years after he began using it.
At first, “I put it in in because I didn’t want to be a hypocrite. Did I think I needed a checklist at the Brigham? No. I wanted to put it in because we were telling Tanzania to do it,” he said. “But I have not gotten through a week of surgery without the checklist catching something.”
“Something” might be an antibiotic that should have been given. Or someone saying the patient previously had back surgery so they should protect his back while he’s on the table. The point is to make well-trained people better, Gawande said.
About a quarter of US hospitals have a version of the checklist in place. Writing in an editorial also appearing in the New England Journal, Dr. John Birkmeyer of the University of Michigan says the Dutch trial should erase any doubts about the common-sense tool.
“Checklists seems to have crossed the threshold from good idea to standard of care,” he said.
About white coat notes
|White Coat Notes covers the latest from the health care industry, hospitals, doctors offices, labs, insurers, and the corridors of government. Chelsea Conaboy previously covered health care for The Philadelphia Inquirer. Write her at firstname.lastname@example.org. Follow her on Twitter: @cconaboy.|
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