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Can a simple checklist prevent surgical errors?

A new study has found that hospitals could cut surgery complications by about 30 percent and resulting deaths by 40 percent if doctors and nurses follow a checklist of safety rules before, during and after performing surgery.

The checklist, issued by the World Health Organization last year in response to soaring reports of hospital errors, lists 19 steps that surgical teams should follow, starting with making sure that the right patient is on the operating table, the site of incision has been located, and that the proper procedure is about to be performed. "In this era of highly intense and sophisticated technology, sometimes a very simple technology, which only takes a few minutes, can have a very positive impact," says Richard Reznick, head of surgery at the University of Toronto in Canada and co-author of the study published today in the New England Journal of Medicine.

He and fellow researchers collected data on surgery complications and deaths of 7,688 surgical patients at eight hospitals in Seattle, Toronto, London, Auckland, Ifakara, (Tanzania), Manila (Philippines), New Delhi (India), and Amman (Jordan).  These hospitals did not initially require use of the WHO safety checklist but adopted it during the course of the study. The goal of the research was to find out how implementing the checklist impacted the number of surgery complications and deaths. Of the 3,733 patients who had surgeries before the checklists went into use, 411 (11 percent) suffered complications (such as pneumonia and skin infections) and 56 (1.5 percent) of them died; of the 3,955 patients who were operated on after the hospitals adopted the WHO guide, 277 (7 percent) suffered complications and 32 (0.8 percent) died.

This study "is an attempt to make this an international standard," says Reznick, noting that the majority of hospitals around the world do not use the guidelines. But he cautions that this is just one way to prevent unnecessary complications and deaths. He says hospitals should also, among other things, mandate infection control programs to prevent post-surgery infections.

Some 234 million major surgeries are performed around the world annually, roughly one operation for every 25 people, according to WHO. The international aid agency estimates that approximately half of all surgical complications are preventable.

"Attention to patient safety will pay dividends, in terms of lessening complications and saving lives," Reznick says. "[The idea is to] try to enact things globally."

Image credit ©iStockphoto.com/Jacob Wackerhausen

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