WHO Proposes Checklist to Reduce Surgery Errors

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Surgical Safety Checklist

Download the checklist.

Since the 1930s, airplane pilots have run through checklists before taking off. Now the World Health Organization wants surgeons all over the globe to use them, too.

Dr. E. Patchen Dellinger, a surgeon at the University of Washington Medical Center in Seattle, says people are surprised when he tells them about the project.

"One of the common reactions is, 'You mean you weren't doing that before? Good heavens!'" he says.

The new WHO checklist has 22 items spread over three stages: before, during and after an operation. Among other things, people on the surgical team must verify that they're about to operate on the right patient, with the right procedure, in the right place. They also must verify if the patient has allergies, if he or she may need blood, if pre-op antibiotics have been administered and, finally, if any instruments or surgical sponges are unaccounted for. (They may have accidentally been left inside the patient.)

Eight medical centers around the world, from Tanzania to England and Seattle to Manila, have been participating in a pilot program using the checklist. At the start of the program, the hospitals were doing everything they should only a third of the time. A thousand operations later, that rate improved to two-thirds of the time, with some hospitals approaching 100 percent.

The WHO tapped Dr. Atul Gawande to head the international task force that devised the checklist. He's a Boston surgeon and a professor at the Harvard School of Public Health who writes frequently about how things go wrong in medicine.

Gawande says there's been some resistance to the list. One London surgeon thought it was demeaning "Mickey Mouse stuff" until one day in the operating room.

"Right before the incision [the medical team] took a timeout," Gawande says, "and when it came to the nurse's turn to raise any concerns, the nurse asked: 'Are we really sure we have the right size knee replacement for this patient?'"

Turns out, they didn't — not anywhere in the hospital. That surgeon now swears by the surgical checklist. And Gawande wants to extend it to other parts of the hospital.

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