Careful US hospitals could save $20 billion a year
Surgery Checklist Lowers Patients' Complications & Death Rate
| Nearly 300,000 deaths a year in American hospitals are due, arguably, to poor medical judgment, incompetence, or neglect. click here That puts hospital mistakes in third place behind the leading killers -- heart disease and cancer, both killing about twice as many people annually (600k) -- and well ahead of strokes and pneumonia, each killing about half as many people (150k). Your taxes support this system, so you have a financial reason, too, to push for improvement. One doctor below pushes for competition among his cohorts and communication among the surgical team. |
By Ceci Connolly, Washington Post Staff Writer, January 15, 2009
Surgical teams that followed a basic cockpit-style checklist in the operating room, from confirming the patient's name to discussing expected blood loss, reduced the rate of deaths and complications by more than a third, according to a year-long, eight-nation project.Surgeons, it seems, are discovering what airline pilots learned decades ago: The human brain can't remember everything, so it's best to focus on the complicated challenges and leave the simple reminders to a cheat sheet. A checklist seems like a no-brainer, but the size of the benefit is dramatic.
The low-cost, low-tech intervention tested in eight hospitals around the globe could have enormous financial implications, as well. If every operating room in the United States adopted the surgical checklist, the nation could save between $15 billion and $25 billion a year on the costs of treating avoidable complications.
In the one-year pilot study involving 7,600 patients, the hospitals saw the rate of serious complications fall from 11 percent to 7 percent. Inpatient deaths declined by more than 40 percent overall, with the most drastic reductions occurring in hospitals with fewer resources.
More than 234 million surgeries are performed worldwide each year, with between 3 and 17 percent resulting in major complications such as a life-threatening infection. In the United States, the average surgical complication costs $12,000 to treat, though as many as half are preventable.
According to the checklist, before an operation begins, the team members introduce themselves, review the patient's name and the procedure to be performed. They discuss allergies, confirm that all equipment has been sterilized and necessary antibiotics administered, and assess potential problems such as blood loss. After the surgery but before the patient leaves the operating room, the team returns to the checklist, labeling specimens and ensuring that all equipment has been removed from the patient. Though the steps are routine, an astonishing number of doctors and nurses miss at least one.
"I cannot recall a clinical care innovation in the past 30 years that has shown results of the magnitude demonstrated by the surgical checklist," said Donald Berwick, the physician president of the Institute for Healthcare Improvement, which promotes high-quality advances in the delivery of care. "This is a change ready right now for adoption by every hospital that performs surgery."
Very few U.S. hospitals are using the surgical safety checklist. The major barrier to widespread adoption is physician attitudes, several experts said. Atul Gawande, a Boston physician who led the study being published in the New England Journal of Medicine, was also skeptical that the checklist would affect the eight to 10 operations he performs each week. Now "I don't get through a week where it has not caught something," he said.
A case in point: Doctors universally say they know the importance of monitoring a diabetic patient's blood sugar levels during surgery. Yet the easy but lifesaving check does not take place in 10 percent of patients, he said.
One of the most effective ways to market the checklist to doctors is to collect data on their performance, said David Flum, a surgeon at the University of Washington Medical Center, which took part in the study. Once they see how they stack up against their peers, physicians are quick to adapt, he said.
Gawande and Flum said they think the checklist improvements came from the intangible benefits of having doctors and nurses work as a team, communicating every step of the way. "You can't really measure the benefit of having the surgeon and anesthesiologist talking to each other and coordinating care," Flum said. As Flum put it: "When I have an operation, please use a checklist on me."
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