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Health March 2013

Aid for Age

Cutting Surgical Errors

By Tait Trussell

A study at eight hospitals worldwide showed death rates dropped by close to half, and other complications also fell drastically after surgeons began using a verbal checklist.

Using a verbal checklist before, during, and after operations has sharply reduced complications and probably can cut the thousands of errors surgeons make each year.

A study at eight hospitals worldwide showed death rates dropped by close to half, and other complications also fell drastically after surgeons began using a verbal checklist.

It’s good news for seniors, who often have to go under the knife for everything from a heart bypass to knee or hip replacement.

A Johns Hopkins University School of Medicine study recently reported in the journal Surgery that mistakes which should never happen in medicine occurred more than 4,000 times a year in the U.S. Mistakes ranged from sewing up a patient when a sponge was left inside the patient to operating on the wrong leg.

The lead author of the study, Martin Makary, professor of surgery at Johns Hopkins, said the estimate of errors was probably low. Many patients don’t even file claims. Maybe some aren’t even aware of an error.

Errors in surgery resulted in 6 percent of the patients dying, and 33 percent had permanent injuries, the study said.

Hospitals, for many years, have been working on ways to avoid “never events,” as they are called. They have used “timeouts” as they are termed before surgery to make sure they have the right patient, and marking the area of the body part before surgery begins.

But the idea of a checklist, such as every airline pilot uses, seems such a simple and expected procedure, it’s a wonder the tool hasn’t been universally used.

The eight hospitals adopting the checklist were in locations from Seattle, Washington, to Ifakara, Tanzania. They made a list of steps to confirm before, during, and after operations. These included such steps as knowing whether the patient has an allergy, confirming that antibiotics were given close enough to the start of the surgery, and having accurate counts of the surgical instruments used.

“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 the lead study author, Dr. Alex B. Haynes. He is a surgeon and a research fellow at the Harvard School of Public Health and Massachusetts General Hospital.

Before and after adopting the checklist, researchers compared surgery outcomes to determine how much the checklist affected the results for the patients operated on in the hospitals in the study.

“The idea of a checklist seems kind of brainless, right?” said Dr. Atul Gawande, associate professor at Harvard School of Public Health and a surgeon at Brigham and Women’s Hospital in Boston, “But the fact is, it’s new to us in medicine,” he told ABC News.

Using the checklist in Michigan saved more than 1,500 lives in a year and $200 million, researchers said.

Many hospitals currently use checklists to aid in avoiding complications in surgery. The novelty of the checklist used in the current study is that it was developed by a consortium of practitioners under the auspices of the World Health Organization and, more importantly, it was oral.

Haynes pointed out that the checklist also was different from that used in most hospitals now in that it’s a team exercise among all members of the operating team.

Although there tends to be much more interest in technological breakthroughs and new drugs, these kinds of procedures, such as oral checklists, may have greater potential to impact sound health care than any other.

 

Tait Trussell is an old guy and fourth-generation professional journalist who writes extensively about aging issues among a myriad of diverse topics.

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