The New England Journal of Medicine published a study in January of 2009, that has the medical world taking a second look. The study conducted in eight hospitals world wide resulted in some startling facts. The study concluded that in the 234 million operations performed every year, surgical complications, are common, and often preventable. The World Health Organization in their 'Safe Surgery Saves Lives' program developed a 19 item surgical safety checklist to keep common problems in the forefront of everyone's minds.
Although surgery can prevent the loss of life, it also comes with its own share of complications. Data suggests that at least half of all surgery complications are avoidable. With previous efforts to lower anesthesia related problems and surgical site infection these complications are reduced significantly. With the addition of the surgery checklist the WHO believes through carefully collected data that the rate of surgery complications and/or death will drop even farther.
Now we might ask ourselves why a surgeon would need a checklist for a task he performs everyday. A single surgeon in a metropolis could easily perform the same surgical procedure over 100 times in a year. With this much repetition we might question why the need for a checklist exists. Whether you adhere to the notions of Ericsson and Kintsch or Miller here is the answer:
Most of our daily activities are done from working memory. The theory is that the human brain only has the ability to hold and recall 7 different pieces of information at a given time. Meaning that the reason why you forget where you put your keys, or where you set the cup of coffee you just made really has nothing to do with how bad or good your memory is. You simply thought of too many different things in a short time period and therefore whipped those items off your memory list. Now if we can forget something in such a short period of time it stands to reason that so can a surgeon.
The surgery checklists are designed to eliminate the need to remember where a surgeon puts a scalpel, set's down the gauze, and who he handed the suture needle to. It is a carefully laid out list that walks a person through the most commonly performed tasks during surgery.
The surgery checklist starts with what is known as "Sign In." The surgeon confirms he has the right patient, and a consent form signed allowing him to do the surgery. The series of questions also makes sure that the anesthesia equipment has been thoroughly checked and found to be in working condition. The team then prepares the patient and the room for the procedure. Anesthesia is administered, blood pressure, and oxygen are all being monitored at this time, and the surgical tools needed have been counted and laid out for use.
"Time Out" is the next stage in the checklist. The questioning goes on to ensure the patient has no known allergies, or any underlying conditions that could complicate the procedure. The surgical team will all identify themselves, and discuss the procedure about to take place and then after everyone is in agreement the procedure can start.
After the surgical procedure is finished the team will begin what is known as "Sign Out". The surgeon confirms that all needles, sponges and surgical instruments are accounted for. Any specimens taken from the patient are labeled and prepared to send to the corresponding labs. The patients post operative care is discussed and notes made for the discharge orders if needed, and the surgery is complete.
The surgery checklist is easy to implement and doesn't add an extreme amount of time to the procedure itself. The whole process from start to finish adds approximately 6 minutes. The checklist isn't costly, and the hospitals that were used for the study were able to implement the steps in less than a month. With preventable surgery complications and death raising the total cost of healthcare around the globe, surgery checklists can play a very vital role in lowering costs, and saving lives.