New Study Reveals The World Health Organization’s Surgical Safety Checklist Reduces Postsurgical Deaths


A new study conducted by a research team from South Carolina Hospital Association, Harvard T.H. Chan School of Public Health and Ariadne Labs reveals a voluntary safety checklist could reduce postsurgical deaths by 22 percent.

The World Health Organization (WHO), an agency of the United Nations that specializes in international public health, developed a surgical safety checklist that is to be used by surgical teams. The checklist covers important questions about the patient’s health, anticipated risks, sterility and standard surgical practices. It is divided into a three-part questionnaire that begins before the induction of anesthesia and ends when the patient is discharged from the operating room.

The Safe Surgery South Carolina program, the first of its kind, examined the impact of the World Health Organization Surgical Safety Checklist in hospitals statewide.The findings revealed a major reduction in postsurgical mortality, when the Surgical Safety Checklist was utilized correctly. Dr. Alex B. Hayes, lead author and associate director of the Ariadne Labs Safety Surgery Program said the findings demonstrate that the checklist can significantly improve patient safety at large scale.

Since the adoption of the checklist in 2009, it has demonstrated to reduce deaths in controlled research studies. While there has been some degree of improvement, outcomes have failed to improve on a larger scale.

All South Carolina-based hospitals were invited to participate in the twelve-step implementation program, which included small scale testing, coaching and observing on checklist performance and customizing the checklist for the local setting. A total of 14 hospitals or about 40 percent of the inpatient surgery volume in South Carolina completed the program.

A 30-day postsurgical mortality outcome from the hospitals that volunteered in the program and those that did not were compared to determine differences, if any. In the analysis, surgical procedures represented various specialties, ranging from orthopedic and soft tissue, neurological, to cardiac and thoracic.

In 2010, prior to the implementation of the program, the postsurgical mortality rate in the 14 hospitals that completed the program was 3.38 percent. In 2013, after implementation, the rate dropped to 2.84 percent. In 2010, the postsurgical mortality rate was 3.5 percent for the hospitals that chose not to participate in the program. In 2013, the rate increased to 3.71 percent. This correlated a 22 percent variance in mortality between the groups.

The Safe Surgery South Carolina program models the best practices in implementing a team-based checklist to boost quality improvement in a surgical center or operating room.

“We are honored to be a learning lab for the rest of the country,” said Thornton Kirby, president and CEO of the South Carolina Hospital Association. “The study validates what we hoped and believed from the outside if you change the operating room culture of how you communicate and coordinate your efforts, you can produce better outcomes.

The findings were published online in the journal Annals of Surgery on April 6, 2017.

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