Surgical To-do Lists are New, Really?

2009-01-15 | |
Last updated: 2009-01-15

Doctor: Clamp
Nurse: Clamp
Doctor: Scalpel
Nurse: Scalpel
Doctor: Sponge
Nurse: Sponge

Based on the cliched television depictions of surgical operations, you might think that a surgical procedure in a hospital would be conducted with the same rigor as a strategic military offensive, but apparently, you would be wrong.

In somewhat troubling but potentially positive news, the New England Journal of Medicine reported that when surgeries were conducted while using a formalized checklist during the surgery, the rate of death was almost cut in half. The checklist used was developed by the World Health Organization and tested during more than 7500 procedures in eight hospitals around the world.

While it is a good thing that such a checklist can have such a dramatic impact, it is concerning that it was not in use before and that so many surgeries are apparently being carried out by the seat of the pants. With so much risk already associated with surgery, it would seem to be an obvious step to check that the activity was proceeding as planned and that all steps needing to be performed were taking place as expected.

What is also very concerning is that if the lack of a checklist results in a doubling of the death rate, then the chance of increased complications also exists when a list is not used. While the study observed that complications reduced from 11 to seven percent through the use of a checklist, the question is whether that takes into account longer term complications. If a surgeon and surgical team is ‘winging it’, albeit with considerable training, it is more than a bit concerning to know that a simple assumption or memory slip could have long lasting personal ramifications.

In the end, it is always good to improve the safely of surgical procedures for patients. However, with findings such as these, it would likely be beneficial for the medical establishment to look for other simple things that could be done to improve patient safety during surgical procedures.

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