Surgical care is an integral part of healthcare, and is sometimes necessary to save lives. At the same time, it is associated with a high risk of possibly-fatal complications.

A study to be published this August 2017 has found that surgery checklists to guide surgical care, can tangibly save lives on a large scale. According to the authors of the study, at least half of all surgical complications are avoidable. Hence, proper surgical care is crucial to the management of injuries and serious conditions.

A large number of surgical complications are avoidable

Hospitals in South Carolina were invited to volunteer for the implementation and completion of a 12-step implementation programme, which is part of the Safe Surgery South Carolina programme.

Collectively, the South Carolina Hospital Association, the Harvard T. H. Chan School of Public Health and Ariadne Labs were in charge of conducting small-scale testing, customising the checklist for local settings, observing and coaching teams on checklist performance.

The study, which involved 14 hospitals, compared 30-day post-surgery mortality results from a number of specialties, including neurological, cardiac and orthopaedic surgery. It was found that death rates post-surgery in hospitals which implemented the checklist programme fell to 2.84% in 2013, compared to 3.38% in 2010, before the programme was implemented.

Hospitals which did not implement the programme reported a mortality rate of 3.71% in 2013, representing a 22% mortality rate difference between the hospitals.

Teamwork in surgery linked to good outcomes

According to the paper, the checklist was designed based on guidelines published by the World Health Organisation (WHO) in 2008 which identified multiple recommended practices to ensure the safety of surgical patients worldwide.

The 19-item checklist is intended to be globally applicable and contains simple but easily overlooked items such as whether the patient has a “known allergy” or “aspiration risk”.

The checklist provides guidance for surgical teams in the consideration of a clear surgical plan, as well as the associated possible risks and concerns, which include infection, blood loss, and organ failure. This serves as a reminder of the possible complications that may occur, allowing them to be caught much earlier.

Finally, the checklist ends by requiring the surgeon, anaesthetist and nurse to discuss the patient’s recovery and management plan, encouraging good follow-up patient care. This further minimises any post-surgery risk.

Checklist to foster teamwork and communication

“Safety checklists are not a piece of paper that somehow magically protect patients,” says lead author Alex Haynes, assistant professor of surgery at Harvard Medical School and associate director at Ariadne Labs.

“… they are a tool to help change practice, to foster a specific type of behaviour in communication, to change implicit communication to explicit in order to create a culture where speaking up is permitted and encouraged and to create an environment where information is shared between all members of the team.”

Hayne concedes one of the main study limitations is that it is not controlled, as it was conducted as an initiative for quality improvement rather than a research project. As such, other possible factors which may contribute to the difference in mortality rate have not been accounted for.

“I'd like to see this type of collaborative in South Carolina lead to collaboratives elsewhere, where we would be able to leverage this knowledge to improve care for patients everywhere,” Haynes commented. MIMS

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