Home E-Weekly April 18, 2017

In South Carolina, Proof that Surgical Safety Checklist Really Works

Published: April 17, 2017

CHECKS AND BALANCES A 19-point checklist prompts members of a surgical team to discuss the surgical plan, as well as any risks or concerns, during each of the 3 phases of a surgery.

South Carolina hospitals that implemented the World Health Organization Surgical Safety Checklist saw a 22% reduction in post-surgical deaths, according to a new study — the first to demonstrate that the Surgical Safety Checklist can significantly improve patient safety at large scale.

The 14 South Carolina hospitals that participated in Safe Surgery South Carolina program saw a 21.9% relative reduction in 30-day post-operative patient mortality. Participating hospitals decreased their 30-day post-operative mortality rate from 3.38% in 2010 — prior to implementation — to 2.84% in 2013, according to a study published in Annals of Surgery. In comparison, the other 44 hospitals in South Carolina had a 30-day post-operative mortality rate of 3.5% in 2010 and 3.71% in 2013.

Adopting a safe surgery checklist has proven to reduce deaths in controlled research studies since 2009. But the ability to produce improved outcomes at large scale to this point has remained elusive.

At the heart of Safe Surgery South Carolina program is a 19-point checklist that prompts members of a surgical team to discuss the surgical plan, as well as any risks and concerns, during each of the 3 phases of a surgical procedure: before the induction of anesthesia ("sign in"); before the incision of the skin ("time out"); and before the patient leaves the OR ("sign out"). In each phase, a checklist coordinator confirms that the surgical team has completed the listed tasks before proceeding.

This 5-year project between the South Carolina Hospital Association (SCHA), Ariadne Labs and the Harvard T.H. Chan School of Public Health was designed as a collaborative effort. Together, participating hospitals implemented the program, which was modeled after the World Health Organization Surgical Safety Checklist developed by a team led by Atul Gawande, MD, executive director of Ariadne Labs.

The success of Safe Surgery South Carolina is the latest evidence supporting the effectiveness of the surgical checklist as a tool for improving patient outcomes. A 2009 pilot study showed similar, significant reductions in post-operative complications and mortality rates in ORs that used a safe-surgery checklist.

SCHA President and CEO Thornton Kirby, FACHE, says South Carolina is honored to act as a "learning lab" for the rest of the country. Furthermore, he says the study has validated the beliefs of the stakeholders from when they embarked on the project in 2010: "If you change the OR culture of how you communicate and coordinate your efforts, you can produce better outcomes."

Bill Donahue

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