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Simple checklist cuts accidental deaths in surgery

WASHINGTON – A simple checklist to confirm a patient’s name, what procedure is to be done, check allergies and count needles and sponges to make sure nothing got left inside halved the rate of surgery-related deaths, doctors reported .

The checklist, similar to those used by pilots before every flight, also slashed the rate of complications, the World Health Organization team reported.

They tested their simple idea with often dubious and unhappy surgical teams operating on more than 7,500 surgical patients in eight hospitals in Toronto, Seattle, London, New Delhi, Amman, Auckland, Manila and Ifakara in Tanzania.

“The death rate was 1.5 percent before the checklist was introduced and declined to 0.8 percent afterward,” the team, led by Dr. Atul Gawande of Harvard Medical School in Boston, wrote in the New England Journal of Medicine.

The death rate from surgery itself is about 0.4 percent to 0.8 percent in the developed world and up to 17 percent of patients have major complications. In this study, the rate of complications fell from 11 percent to 7 percent.

“Applied on a global basis, this checklist program has the potential to prevent large numbers of deaths and disabling complications,” the international team wrote.

Gawande said the items on such a list may appear to be blindingly obvious, but the process itself of painstakingly checking potential errors can help prevent careless mistakes.

It included checks on anesthesia, blood supply, sterile equipment and drugs, requires double-checks of the site to be operated on and an out-loud roll call of the surgical team.

“The concept of using a brief but comprehensive checklist is surprisingly new to us in surgery. Not everyone on the operating teams were happy to try it,” Gawande said.

“But the results were unprecedented. And the teams became strong supporters.”

His team reported on the idea last June in the Lancet medical journal, and the eight-nation test has now supported the initial findings.

He believes such checklists could help many different areas of medicine, including prevention of hospital-acquired infection, cancer treatment and everyday checkups.

“The checklists must be short, extremely simple, and carefully tested in the real world. But in specialties ranging from cardiac care to pediatric care, they could become as essential in daily medicine as the stethoscope,” he said.