Checklists cut surgery deaths by one third in Boston

Harvard researchers report in the Boston Globe

Deaths and complications dropped by an astounding one-third when operating room doctors and nurses completed a simple safety checklist before, during, and after surgery, according to a study led by Harvard researchers.

The eight hospitals that participated in the international study collectively reduced complications during hospital stays from 11 percent of patients before they began using the checklist to 7 percent of patients when using the checklist. Deaths dropped from 1.5 percent of patients to 0.8 percent.

"It was beyond anything we expected," said Dr. Atul Gawande, senior author of the Harvard School of Public Health paper and a surgeon at Brigham and Women's Hospital. The impact of all the items on the checklist "put together seems to have produced these really remarkable results," he said.
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Completing the checklist out loud as a team is crucial to uncovering lapses that lead to problems, said Dr. Alex Haynes of the Harvard School of Public Health, the lead author and a surgeon at Massachusetts General Hospital.

"Saying it verbally codifies things more than simply having one person check a box," Haynes said. It requires more attention, he said, and a greater sense of collective responsibility.

I posted The Art of Managing Extreme Complexity in the ICU over a year ago which excerpted chunks of Atul Gawande's article in the New Yorker.

One doctor looked at what happens when procedures are too complex to carry out reliably from memory alone by taking a page from pilot checklists.

Checklists help people with memory recall and make explicit the minimum, expected steps in complex processes.

What checklists do you use?