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    WHO Surgical Safety Checklist Greatly Reduces Mortality Rates

    By Jennifer Huddleston, staff writer     

    A pilot study of the Surgical Safety Checklist developed by the World Health Organization (WHO) to improve team communication and consistency of care found that utilizing the checklist reduced surgery-related death rates by more than 40 percent. [1]

    An estimated 234 million operations are performed annually and the mortality rate attributed to general anesthesia is as high as one in 150 patients in some third-world countries.
    [2] However, research suggests that at least half of all surgical complications are preventable. [3]

    The researchers leading the study hypothesized that implementing the WHO’s 19-item Surgical Safety Checklist would reduce surgery-related complications and deaths through improved teamwork and adherence to WHO safety guidelines.
    [4]

    The study included 7,688 patients at least 16 years of age who underwent non-cardiac surgery between October 2007 and September 2008. Approximately half of the patients (3,733) underwent operations prior to the implementation of the checklist and 3,955 were treated after the checklist was introduced.
    [5]

    The checklist reduced the overall rate of complications during hospitalization within the first 30 days after surgery from 11 percent to 7 percent.
    [6]

    “Results from the pilot study are startling,” said Atul Gawande, M.D., chief investigator for the WHO’s Safe Surgery Saves Lives group, in a prepared statement. “They indicate that gaps in teamwork and safety practices in surgery are substantial in countries both rich and poor.”
    [7]

    The Surgical Safety Checklist was tested in eight hospitals worldwide, including: [8]

    • District Hospital in Ifakara, TanzaniaPhilippine General Hospital in Manila, Philippines Prince Hamza Hospital in Amman, Jordan
    • St. Mary’s Hospital in London, United Kingdom
    • St. Stephen’s Hospital in New Delhi, India
    • The University of Auckland in Auckland, New Zealand
    • The University of Toronto in Toronto, Canada
    • The University of Washington Medical Center in Seattle, Washington

    The checklist is used at three points in the operating room: before anesthesia is administered, before the initial incision is made and before the patient leaves the operating room. Elements of the checklist include introductions of surgical team members, sponge and needle counts, planning for a difficult airway, antibiotic prophylaxis one hour prior to surgery and the use of pulse oximetry. [9]

    “As intuitive and logical and every-day as these checklist items appear, making them systematic practice for every surgical case sooner or later will reveal something that will save a life,” said John Eichhorn, M.D., an anesthesiologist on an international expert panel advising the WHO on the surgical safety initiative. [10]

    Ireland, Jordan and the Philippines have already implemented the WHO Surgical Safety Checklist nationwide, and the National Patient Safety Agency of the United Kingdom’s National Health Service in January 2009 called for all healthcare organizations in England and Wales to adopt an adapted version of the checklist by February 2010. The Canadian Patient Safety Institute currently is devising a version of the checklist for possible implementation by September 2009.
    [11]

    Both the American Society of Anesthesiologists and the World Federation of Societies of Anesthesiologists have approved the checklist in principle.
    [12]

    The findings of the study are published in the Jan. 29, 2009, issue of The New England Journal of Medicine. For more information on the WHO Surgical Safety Checklist, visit
      www.who.int .


    [1] Beresford, Larry. “WHO Checklist Promotes Surgical Safety Worldwide.” Anesthesiology News , Volume 35:4. April 2009.
    [2]  Ibid.
    [3] Haynes, Alex B., et al. “A Surgical Safety Checklist to Reduce Morbidity and Mortality in a Global Population.” New England Journal of Medicine.  Volume 360:491-499. Jan. 29, 2009.
    [4]  Ibid.
    [5]  Ibid.
    [6]  Ibid.
    [7] Beresford, Larry. “WHO Checklist Promotes Surgical Safety Worldwide.” Anesthesiology News , Volume 35:4. April 2009.
    [8]  Black, Cherie. “Surgery Checklist Is all About the Patient.” Seattle-Post Intelligencer. June 25, 2008.
    [9] Beresford, Larry. “WHO Checklist Promotes Surgical Safety Worldwide.” Anesthesiology News , Volume 35:4. April 2009.
    [10]  Ibid.
    [11]  Ibid.
    [12]  Ibid.



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