Surgical safety checklist saves lives?

Abstract

The WHO Safe Surgery Saves Lives Study Group has recently published a study of surgical outcomes before and after implementation of a surgical safety checklist in the New England Journal of Medicine.1 After implementation, deaths were reduced by 47% and in-hospital complications by 36%. The observed improvement was seen across eight different study hospitals based in high, middle and low income countries. As suggested by the authors, whereas the exact mechanism for the observed improvements in outcomes is unclear, it is almost certainly multifactorial. On the basis of these startling results, the National Patient Safety Agency in the United Kingdom has issued an alert mandating that an adapted version of the checklist should be completed for every patient undergoing a surgical procedure in England and Wales, with full implementation by February 2010.2 The goals are quite clear – to improve anaesthetic safety practices, to ensure correct site surgery, to avoid surgical site infections and to improve communication within the team. Although the checklist looks simple, logical and impressive, the sceptics are quietly watching its development. Some surgeons or surgical units that do not implement such a checklist would show people a clean balance sheet with no mishaps in their own results to prove that there is no need of such a checklist. Some would suggest that their current practice of ‘time-out’ or ‘briefing’ would be more than adequate in preventing surgical incidents. Worse still, some may simply regard the adoption of such a checklist as an admission that their practices are unsafe. Perhaps, by adopting a checklist, as is done in aviation and other industries, some would feel a drop in the professional pride of their work in hospitals. Whether surgeons around the globe would embrace this new wave of surgical safety checklists with open arms remains to be seen. Some surgical units would use the top-down approach and some would use the bottom-up approach. It does not really matter that much. The devil is there in the implementation. For example, mechanical compliance with a simple tick-box exercise would not bring about any significant changes. Underneath that single sheet of paper is the need to change our surgical culture – surgeons are expected to be safer than just safe. If we surgeons become patients ourselves, wouldn't it be nice to know everyone in the operating theatre (OT) – anaesthetists, surgeons and nurses – are spending a few minutes (while you have been put to sleep with a tube in your throat!) ensuring that all OT team players know the surgical plan and have the correct instruments handy?