Verbal Checklist May Cut Surgical Errors

Jan. 14, 2009— -- Surgeons who used a verbal checklist before, during and after operations were able to drastically reduce complications, according to a new study that some doctors say may be too good to be true.

The year-long study at eight hospitals worldwide showed death rates dropping by nearly half, to 0.8 percent from 1.5 percent, and other complications falling to 7 percent from 11 percent after surgical teams started using a verbal checklist.

"The take-home message is that a relatively simple tool, a checklist ... can help to improve team function, ensure the performance of known safety practices, and ultimately reduce complication and death following surgery," said lead study author Dr. Alex B. Haynes, a surgeon and research fellow at the Harvard School of Public Health and Massachusetts General Hospital.

For the study, eight hospitals in places from Seattle to Ifakara, Tanzania, adopted a list of steps to confirm before, during and after operations. These included steps such as knowing whether the patient has an allergy, confirming that antibiotics were given close enough to the start of surgery, and having accurate counts of surgical tools used.

Researchers compared surgery outcomes before and after adopting the checklist to see how much it affected the results for patients operated on in the hospitals.

"The idea of a checklist seems kind of brainless, right? We must be doing this all the time, but in fact, it's new to us in medicine," Dr. Atul Gawande, associate professor at HSPH and a surgeon at Brigham and Women's Hospital in Boston told ABC News medical correspondent John McKenzie. "The reason we ended up focusing on the idea of a checklist is because of work that a researcher at Johns Hopkins did showing that a simple checklist for I.V.'s in the intensive care unit could reduce their infection rate massively.

"Putting in that checklist in the state of Michigan saved more than 1,500 lives a year, $200 million dollars. We said if they can do that for something as simple as an I.V., we could possibly make a lifesaving checklist for surgery, 2,000 different kinds of surgical procedures."

Many hospitals presently use checklists to help avoid complications in surgery. Haynes said the novelty of the checklist used in the current study, which was developed by a consortium of health practitioners under the auspices of the World Health Organization, was that it was verbal, rather than a paper checklist, and required more interaction between surgical team members.

The idea for the checklist actually came from aviation.

"We followed almost the way they do in aviation. There is a checklist part for before you take off, there's a checklist for in the air, there's a checklist before landing. And we did the same thing," said Gawande.

Haynes noted that the checklist differed from those used in most hospitals now.

"This checklist is different in that it's a team exercise among all the members of the operating team," Haynes said.