Surgical Safety Checklists
Surgical Safety Checklists
The concept of using a checklist in surgical and anaesthetic practice was energized by publication of the WHO Surgical Safety Checklist in 2008. It was believed that by routinely checking common safety issues, and by better team communication and dynamics, perioperative morbidity and mortality could be improved. The magnitude of improvement demonstrated by the WHO pilot studies was surprising. These initial results have been confirmed by further detailed work demonstrating that surgical checklists, when properly implemented, can make a substantial difference to patient safety. However, introducing surgical checklists is not as straightforward as it seems, and requires leadership, flexibility, and teamwork in a different way to that which is currently practiced. Future work should be aimed at ensuring effective implementation of the WHO Surgical Safety Checklist, which will benefit our patients on a global scale.
Complications due to healthcare are well documented and constitute an important public health problem. A number of studies have described an adverse event rate of 3–17% in hospitals in North America, Australia, New Zealand, Denmark, and the UK. The human cost to patients, families, and their carers is considerable, as is the cost to health-care systems. Adverse events in healthcare are estimated to result in more deaths in the USA annually than road traffic accidents, breast cancer, or acquired immune deficiency syndrome, and it has been estimated that adverse events in the NHS cost £1bn and require an additional 3 million bed days annually. Adverse events associated with surgery deserve particular attention—a recent systematic review suggested that the most common location of adverse events in hospital was the operating theatre. Most were associated with a surgical care provider (although few directly related to anaesthesia), and 43% of the incidents were preventable using the current standards of care. If published complication rates from surgery are extrapolated to a global population (estimated 234M operations performed annually), surgery may be responsible for 7 million complications and 1 million deaths every year, twice the number of maternal deaths.
The US Institute of Medicine report 'To err is human' was published more than 10 yr ago and called for efforts to reduce the epidemic of healthcare-related complications. In England and Wales, the Chief Medical Officer's report 'An organisation with a memory' similarly highlighted the need to improve the safety of care in the NHS and the National Patient Safety Agency (NPSA) was established as a consequence. An additional reporting arm of the NPSA was established at the same time (the National Reporting and Learning Service; NRLS), which now contains the largest database of adverse events in healthcare worldwide.
It is interesting to consider the impact of reporting incidents and how effective this is at improving the safety of healthcare. There have been more than 6 million reports to the NPSA to date, most of them minor, but the absolute numbers of those injured are high. Data from the most recent report indicate that 10 875 patients died or came to severe harm from adverse events during 2010–11, with more than 4000 events due to errors in the treatment or procedure, or implementation of care and ongoing monitoring/review. The analytical capacity required to evaluate this information is enormous, but without this, there is very little to be gained from national incident reporting.
How can errors in healthcare be reduced? Training in anaesthesia and surgery has typically focused on technical skills and technological innovation. Improving safety requires an understanding of the science of error and a consideration of human factors and systems failures, recognizing the need to improve the organizational safety culture and to train to avoid and mitigate errors when they occur. Quality improvement initiatives that focus on the implementation of simple evidence-based interventions are likely to offer opportunities to improve care for our patients. This was highlighted in the Darzi review 'High quality care for all' linking safe care with effective care; 'getting the basics right, first time, every time'. This approach of doing the right thing, every time, for every patient, is the basis of a number of checklists recently introduced in healthcare and will be described further in this review, along with available evidence to support their use.
Abstract and Introduction
Abstract
The concept of using a checklist in surgical and anaesthetic practice was energized by publication of the WHO Surgical Safety Checklist in 2008. It was believed that by routinely checking common safety issues, and by better team communication and dynamics, perioperative morbidity and mortality could be improved. The magnitude of improvement demonstrated by the WHO pilot studies was surprising. These initial results have been confirmed by further detailed work demonstrating that surgical checklists, when properly implemented, can make a substantial difference to patient safety. However, introducing surgical checklists is not as straightforward as it seems, and requires leadership, flexibility, and teamwork in a different way to that which is currently practiced. Future work should be aimed at ensuring effective implementation of the WHO Surgical Safety Checklist, which will benefit our patients on a global scale.
Introduction
Complications due to healthcare are well documented and constitute an important public health problem. A number of studies have described an adverse event rate of 3–17% in hospitals in North America, Australia, New Zealand, Denmark, and the UK. The human cost to patients, families, and their carers is considerable, as is the cost to health-care systems. Adverse events in healthcare are estimated to result in more deaths in the USA annually than road traffic accidents, breast cancer, or acquired immune deficiency syndrome, and it has been estimated that adverse events in the NHS cost £1bn and require an additional 3 million bed days annually. Adverse events associated with surgery deserve particular attention—a recent systematic review suggested that the most common location of adverse events in hospital was the operating theatre. Most were associated with a surgical care provider (although few directly related to anaesthesia), and 43% of the incidents were preventable using the current standards of care. If published complication rates from surgery are extrapolated to a global population (estimated 234M operations performed annually), surgery may be responsible for 7 million complications and 1 million deaths every year, twice the number of maternal deaths.
The US Institute of Medicine report 'To err is human' was published more than 10 yr ago and called for efforts to reduce the epidemic of healthcare-related complications. In England and Wales, the Chief Medical Officer's report 'An organisation with a memory' similarly highlighted the need to improve the safety of care in the NHS and the National Patient Safety Agency (NPSA) was established as a consequence. An additional reporting arm of the NPSA was established at the same time (the National Reporting and Learning Service; NRLS), which now contains the largest database of adverse events in healthcare worldwide.
It is interesting to consider the impact of reporting incidents and how effective this is at improving the safety of healthcare. There have been more than 6 million reports to the NPSA to date, most of them minor, but the absolute numbers of those injured are high. Data from the most recent report indicate that 10 875 patients died or came to severe harm from adverse events during 2010–11, with more than 4000 events due to errors in the treatment or procedure, or implementation of care and ongoing monitoring/review. The analytical capacity required to evaluate this information is enormous, but without this, there is very little to be gained from national incident reporting.
How can errors in healthcare be reduced? Training in anaesthesia and surgery has typically focused on technical skills and technological innovation. Improving safety requires an understanding of the science of error and a consideration of human factors and systems failures, recognizing the need to improve the organizational safety culture and to train to avoid and mitigate errors when they occur. Quality improvement initiatives that focus on the implementation of simple evidence-based interventions are likely to offer opportunities to improve care for our patients. This was highlighted in the Darzi review 'High quality care for all' linking safe care with effective care; 'getting the basics right, first time, every time'. This approach of doing the right thing, every time, for every patient, is the basis of a number of checklists recently introduced in healthcare and will be described further in this review, along with available evidence to support their use.
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