A new study suggests that adopting the World Health Organization's pre-surgical checklist had little impact on 1 hospital's surgical patient mortality rate. The checklist's effectiveness, researchers say, depends largely on a surgical team's full completion of it.
For the study, researchers at University Medical Center Utrecht in the Netherlands found that the death rate among surgery patients dipped only 0.3% (from 3.1% to 2.8%) in the 18 months following the center's adoption of the WHO checklist. In 2009, a similar multi-national study of 8 hospitals found the overall death rate among surgery patients at those facilities dropped from 1.5% to 0.8% in the year after they began using the WHO checklist.
Researchers in the Dutch study, however, noted that much depended on whether surgical teams actually completed the checklist. Patients with fully completed checklists, for instance, were found to have about one-third of the death risk of those without checklists. Researchers found that the lists were completed for only 39% of patients.
According to researchers, one reason for that outcome was that patients in critical need of emergency surgery were less likely to have had a checklist completed before surgery. However, that fact did not seem to explain the lower death risk among patients whose checklists were fully completed, the researchers noted.
"Mortality was strongly associated with checklist compliance, suggesting that large variations in the level of implementation for different groups of patients need to be reduced," says study co-author Wilton A. van Klein.
The minimal decline in patient death rate seen in the recent study as compared to the 2009 study might also be attributable to the difference between the hospitals studied. The Dutch researchers note that theirs is a university hospital that tends to receive more critically ill patients than a community hospital would. Additionally, the overall death rate among the university hospital's patients was higher than the average seen in the 2009 study, which included both university and community hospitals.
Mark McGraw
