Dr. Atul Gawande leads the HIROC-sponsored session on patient safety at HealthAchieve.
Checklist a useful patient safety tool, potential life-saver, says doc
Surgeon, Harvard Medical School prof leads patient safety session at HealthAchieve
Tuesday November 11, 2008 -- Natalie Miller
TORONTO — Using a checklist in the operating room is one tool that can help reduce risk for error and save lives, participants heard recently during a session at the Ontario Hospital Association's HealthAchieve in Toronto.

Dr. Atul Gawande, assistant professor at Harvard Medical School, surgeon, writer and teacher, led the discussion on patient safety Nov. 3. The patient safety session was sponsored by HIROC.

Through an engaging talk, Gawande outlined developments in patient safety and highlighted a World Health Organization (WHO) project in which he was involved. Although he is a surgeon, Gawande presented the information from a perspective that was relevant to other healthcare professionals as well.

"You are in the world of the same set of problems we grapple with," Gawande said.

"What does patient safety mean?" It essentially means attempting to reduce avoidable complications and deaths, he said.

Gawande spoke about his involvement in the WHO's Safe Surgery Saves Lives initiative. As part of the project, eight healthcare centres around the world took part in piloting a checklist in their operating rooms. Hospitals in the United Kingdom, United States, Canada, Tanzania, Jordan, the Philippines, India and New Zealand participated.

The checklist involves asking questions at three points in the operating room — prior to administering anaesthesia, prior to making the incision and prior to the patient leaving OR after the procedure.

For instance, prior to anaesthesia, three points on the checklist are: confirming the correct patient by name, confirming the procedure being performed and confirming any known allergies.

Prior to making the incision, three points on the checklist are: confirming all team members are identified by name and role, confirming antibiotics have been administered within 60 minutes prior to the procedure and confirming whether there are any anticipated critical or unexpected steps related to the operation.

Prior to the patient leaving OR after the procedure, three points on the checklist are: confirming the name of the procedure is recorded, confirming that instrument, sponge and needle counts are correct and confirming post-operative care needs/concerns are addressed.

Gawande said the keys to a productive checklist are keeping it short and zeroing in on critical points. He also noted when nurses and members of the operating team identify themselves by name they are more likely to have the confidence to speak up if they have any questions or concerns during the procedure.

The surgeon said initial results suggest the checklist reduced complications across the board. According to WHO, preliminary results from 1,000 patients in the eight pilot sites indicate the checklist nearly doubled the likelihood that patients will receive proven standards of surgical care.

"Use of the checklist in pilot sites has increased the rate of adherence to these standards from 36 per cent to 68 per cent and in some hospitals to almost 100 per cent. This has resulted in substantial reductions in complications and deaths in the 1,000 patients."

As well, some participating countries have made commitments to roll out the checklist as a result. In Canada, there are impending discussions with the Ontario Hospital Association and the Canadian Patient Safety Institute about the checklist, Gawande added.

In conclusion of his discussion about patient safety, Gawande said, "Most of the time, for most patients, we do it right." But not for all patients, all of the time. "That is what patient safety is about."

For more information about Safe Surgery Saves Lives and to view the checklist, click here.

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