Healthcare News & Insights

Checklists improve outcomes for surgery

Hospitals that aren’t using surgical checklists could be putting patients in unnecessary danger. A new study shows just how effective checklists are at keeping patients safe from preventable harm – and even death – during many common procedures. 

ThinkstockPhotos-501784570The study, published in the Journal of the American Medical Association (JAMA) Surgery, looked at the outcomes of over 10,000 patients who received non-cardiac surgery both before and after a surgical-safety checklist was introduced at a hospital in Europe.

Three checklists were used at the hospital:

  • a comprehensive surgical safety checklist with 24 items for standard procedures
  • a modified checklist with 17 items for same-day or short-term procedures, and
  • a 22-item checklist specifically for C-sections.

All checklists were created based on guidelines from the World Health Organization (WHO). Each one was completed in the operating room by the doctors and nurses caring for the patient, and each adhered to the WHO’s three phases of surgery: sign-in (before anesthesia is administered), time-out (before the incision of the skin) and sign-out (before the patient leaves the operating room).

Staff members were asked to write down any performance errors on a separate back sheet in the surgery area. Researchers determined that proper protocol was followed if each item on the checklist was filled out correctly, no performance errors were noted, and there was clinical evidence the checklist was used.

According to the analysis, checklists improved patient care in a variety of areas. After the checklists were implemented, death rates within both 30 days of surgery and 90 days of surgery decreased. In addition, the average length of patients’ hospital stays went from 10.4 days to 9.6 days.

And, here’s another area of success that should interest hospitals: 30-day readmission rates declined when using surgical checklists.

Keys to implementing checklists

All that adds up to big benefits for hospitals when using checklists, including lower costs and less scrutiny from the feds.

But barriers exist to their implementation – namely, getting all staff members to buy into the idea of using a checklist for every surgery, which may require a cultural change in your hospital.

According to the WHO, factors which increase the chances of successfully implementing a checklist in your facility include:

  • Early engagement of staff. Doctors, nurses and other staff who will be affected by the checklist should be involved in the process from the start, using their suggestions and ideas to create a checklist that fits into the current surgical workflow.
  • Active leadership and identification of local champions. Hospital executives must show they take safety seriously and are in full support of the checklist. And other leaders, such as head nurses, should be recruited as well.
  • Extensive discussion, education and training. Staff should receive regular training about the best ways to use surgical checklists. They should also be encouraged to ask questions and give feedback about how it’s working.
  • Multidisciplinary involvement. Along with administrators and leaders, representatives of surgeons and staff from all specialties need to give their input on the checklist.
  • Coaching. Staff should be supported throughout the checklist implementation process. Errors should be seen as opportunities for improvement instead of reasons for punishment.
  • Ongoing feedback. Each surgery can be viewed as an opportunity to improve the checklist’s effectiveness. Performance must be evaluated on a regular basis so clinical staff know what they’re doing well and where improvement is needed.
  • Local adaptation. While some basic elements are standard, any templates your hospital uses for checklists should be adapted to fit providers’ needs, and the procedure that’s being performed.

The WHO has a basic surgical safety checklist hospitals can adapt to their own needs, as well as an implementation guide.

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