How A Checklist Affected Surgical Death Rates

a US quarter with South Carolina on the backSurgical checklist reduced surgery deaths in South Carolina hospitals.

Pilots have long used pre-flight checklists to decrease the risk of accidents. Now that strategy is being applied to surgical procedures.

A collaborative five-year project in South Carolina hospitals showed that the consistent use of surgical checklists significantly decreased the death rate. Although surgical checklists have been around for a while, this was the first study to look at the large-scale public health impact.

Lead author Alex B. Haynes, MD, MPH, commented in a press release, “That is a major reduction in post-surgical mortality and it demonstrates that when done right, the Surgical Safety Checklist can significantly improve patient safety at large scale.”

Dr. Haynes is a surgical oncologist at Massachusetts General Hospital and associate director of the Ariadne Labs Safe Surgery Program.

Dr. Haynes and colleagues used the World Health Organization Surgical Safety Checklist in 14 hospitals. In addition to using a standardized checklist, participating hospitals customized the checklist to their individual settings, started with small-scale testing and coached staff in the use of the checklists.

The researchers then compared mortality rates at 30 days post-surgery with hospitals in the state that weren’t using the checklist. The death rate in hospitals using the checklist was 22 percent lower compared to non-participating hospitals.

surgical safety checklist example
Example of surgical safety checklist: WHO

The standardized 19-item checklist helps prompt surgical team members to discuss the surgical plan, risks and concerns. It’s not just a matter of checking the boxes, but of encouraging dialogue that can help protect patients from surgical risks such as bleeding, infections and other complications.

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

The study was published in the April issue of Annals of Surgery.

Funding for the study was provided by Branta and Rx Foundations and the Agency for Healthcare Research and Quality (AHRQ).

None of the authors reported a conflict of interest.

Harvard T.H. Chan School of Public Health, “South Carolina hospitals see major drop in post-surgical deaths with safety checklist”
Annals of Surgery, “Mortality Trends After a Voluntary Checklist-based Surgical Safety Collaborative.”
Written by: Beth Greenwood, RN | Medically reviewed by: Dr. Robert Carlson, M.D.