Those who practice modern medicine work diligently to prevent and manage illness, to abate suffering and to preserve lives. Though their record of success is astonishingly good, it is still far from perfect. The effort to produce better medical outcomes continues with beneficial results. A new study, for example, strongly suggests that the use of checklists is a low-cost and a highly efficient way to improve patient safety in operating rooms across the country.
The idea of a checklist is not new. Versions of them have been used for years. Typically, though, they have been limited to counting instruments or asking a patient his or her name and to verify what type surgery was planned prior to the administration of anesthesia. The checklist protocols reported in the New England Journal of Medicine are far more rigorous. They also are far more useful.
The checklists used in the study fundamentally change the dynamic in the operating room. The surgeon is still in charge, but he or she no longer has exclusive control over what takes place. Instead, medical personnel are encouraged to develop personal checklists particular to their field of expertise, to discuss the procedure, and to examine the patent’s medical history prior to the operation. More general but still extensive checklists are still employed. The result, as one observer noted, is similar to what pilots do on the ground before taking to the air.
The result of the broader, more detailed approach to surgery as reported in the journal is simply astounding.
Initial studies at a handful of hospitals in a pilot program indicated the checklists reduced deaths and serious complications by about half. That prompted a far more detailed study of checklist use. The results of the latter were equally noteworthy. The journal study reported that complications were reduced from 27 to 17 per 100 patients and that deaths fell from 1.5 to 0.7 patients per 100. In medicine, where life-and-death events are an everyday occurrence, such declines are eye-catching.
Clearly the introduction of detailed checklists and the team approach into the nation’s surgical suites should be expedited. Almost all Veterans Administration hospitals and about a fourth of the nation’s hospitals already have adopted their use. The quicker other institutions follow, the healthier and safer their patients will be.
There’s no reason for delay. The new methodology costs hospitals little or nothing to implement, and the outcome is almost universally beneficial. That’s a prescription that all involved should accept without unnecessary debate or undue bureaucratic wrangling.