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8.5" x 11"

By Jock Hoffman, CRICO

Related to: Communication, Nursing, Surgery, Teamwork Training

Amidst millions of dollars worth of state-of-the-art, high-tech, equipment, a single piece of paper is saving lives in the operating room. And you can have it for free.

The success of the one-page Surgical Safety Checklist, developed and distributed by the World Health Organization (WHO), has been widely reported since the results of an international study were published in January. What is remarkable is the speed with which hospitals have been willing to adopt it, and even mandate its use. Clearly, the need was real, the tool is simple enough to use, and the results are convincing. Even before the findings were made public, a number of hospitals around the world had fully adopted the freely available WHO checklist as their standard procedure. The study data just confirmed what they were seeing demonstrated in their ORs: using the checklist reduces the risk of a preventable surgical error.

The study authors predict that worldwide use of the 19-step checklist could prevent more than a million deaths and 10 million avoidable complications every year, at the cost of about 90 seconds per operation. Using the checklist should also help reduce the surgeons’ risk of being sued for malpractice. In the CRICO system, surgery-related cases account for 23 percent of cases and 22 percent of indemnity paid out to patients and their families (just over $51 million from 2004–2008). Of the 253 surgery cases filed from 2004-2008, 49 percent involved an (alleged) communication breakdown, and, improving communication—before, during, and at the close of surgery—is primarily what the WHO checklist targets.

Conception, development, pilot testing, training, and refinements for the WHO checklist consumed significant time, resources, and salesmanship. In the end, of course, that piece of paper is just a tool to focus the clinicians’ attention on some tasks that are so routine that they can be (and often are) overlooked. The genius is in its simplicity: no new equipment, no new software, no additional staffing—nothing more than a pen and a sincere commitment to use it every time, to make it a habit.

Of course, habits are hard to change and the WHO checklist engenders the usual resistance to change and concerns that it will upset OR schedules…and (sometimes) intractable surgeons. But the groundswell of support after less than a year implies that the benefits, and its ease of adoption and use, serve to counter the dissonance. With the NEJM study results and early adopters testimonials in hand, hospitals eager to see similar safety improvements shouldn’t have too much trouble getting everyone to check off the box marked YES.

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February 2, 2009
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