Global medical safety advance
by the World Health Organization

A collection of hospitals in eight cities around the globe has successfully demonstrated that the use of a simple surgical checklist, developed by the World Health Organization (WHO), during major operations can lower the incidence of deaths and complications following surgery by one-third.

Analysis of studies undertaken in participating hospitals in each of the six WHO Regions, shows that the rate of major complications after undergoing surgery in the operating rooms taking part in the study fell from 11 percent in the baseline period to 7 percent after introduction of the checklist, a reduction of one third. Inpatient deaths following major operations fell by more than 40 percent (from 1.5 percent to 0.8 percent) with implementation of the checklist.

“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. But the results were unprecedented. And the teams became strong supporters,” said Dr. Atul Gawande, main author of the study and team leader for the development of the WHO Surgical Safety Checklist.

Data was collected from 7,688 patients --- 3,733 before the implementation of the checklist and 3,955 after the checklist was introduced.

The study was carried out in hospitals in both high and lower income settings --- in Ifakara (Tanzania), Manila (Philippines), New Delhi (India), Amman (Jordan), Seattle (United States of America), Toronto (Canada), London (United Kingdom) and Auckland (New Zealand). The reductions in complications proved to be of equal magnitude in high and lower income sites in the study.

“These findings have implications beyond surgery, suggesting that checklists could increase the safety and reliability of care in numerous medical fields,” Gawande said. “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.’

The safe surgery checklist which was launched by the WHO as a recommended guideline for safe practice last year, has since gained global recognition by operating theater staff including surgeons and anesthetists.

It requires only a few minutes to complete at three critical points during operative care --- before anesthesia is administered, before skin incision and before the patient leaves the operating room. It is intended to ensure the safe delivery of anesthesia, appropriate prophylaxis against infection, effective teamwork by the operating room staff and other essential practices in perioperative care.

“The immediate response to the checklist has been remarkable, and the studies undertaken in the pilot hospitals are significant. They will make a major contribution towards our goal of having 2,500 hospitals around the world using the safe surgery checklist by the end of this year” said Sir Liam Donaldson, Chair of the WHO World Alliance for Patient Safety and Chief Medical Officer for England.

The results of the study are published online first on 14 January 2009 on the website of the New England Journal of Medicine (www.nejm.org). The material will appear in the 29 January 2009 printed issue of the journal.

More information on the WHO Safe Surgery Saves Lives initiative can be found at www.who.int/safesurgery.