WHO Proposes Checklist to Reduce Surgery Errors The safety checklist has 22 items spread out over the before, during and after stages of an operation. During a pilot program, hospitals initially said they were adhering to proven standards of care only a third of the time. That rate later improved to two-thirds of the time.
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WHO Proposes Checklist to Reduce Surgery Errors

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WHO Proposes Checklist to Reduce Surgery Errors

WHO Proposes Checklist to Reduce Surgery Errors

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Here's a number for you to contemplate. People around the world undergo more than 230 million major surgical operations each year. That number, thanks to a study this week in the British Journal, the Lancet, that's one operation for every 25 people. The World Health Organization says surgery isn't nearly as safe as it could be, even in rich countries, so it's launching an effort to improve things, using a tool no more complicated than your grocery list. NPR's Richard Knox reports.

RICHARD KNOX: The WHO wants every hospital around the world to start using its simple checklist. For patient Daniel Bockstee(ph), it starts even before he's wheeled into the operating room at the University of Washington Medical Center. Nurse Brian Green has some questions.

Mr. BRIAN GREEN (Nurse, University of Washington Medical Center): I know what we're doing for you today, but I have to ask you to tell me.

Mr. DANIEL BOCKSTEE: Two hernias, going to fix two hernias.

Mr. GREEN: Okay. And they're bilateral groin, correct?

KNOX: Once Bockstee's asleep in the O.R., surgeon Brant Oelschlager calls a halt to the proceedings.

Dr. BRANT OELSCHLAGER (Surgeon, University of Washington Medical Center): Okay, everybody ready for the time out? Let's first everyone in the room introduce themselves so we know who the team is.

MATT (Anesthesiologist): I'm Matt, anesthesia.

TONY (Medical Student): Tony, medical student.

PALPARA(ph) (Surgery Resident): Palpara, surgery resident.

KNOX: After everybody knows who's who, Oelschlager runs through part two of the new checklist.

Dr. OELSCHLAGER: We're going to do a laparoscopic bilateral inguinal hernia repair today. Has the patient had DVT prophylaxis with subcutaneous heparin?

Unidentified Woman: Yes.

KNOX: A surgical checklist is new. Dr. Patchen Dellinger of the University of Washington says people are often surprised to hear it.

Dr. PATCHEN DELLINGER (University of Washington): When I explain to people who are not in medicine that we're introducing a formal checklist process into the operating room, one of the common reactions I get is, you mean you weren't doing that before? Good heavens.

KNOX: But there's plenty of evidence that the absence of a systematic check is causing many an operating room disaster.

Dr. DELLINGER: You only have to pick up the newspapers to read about patients, you know, having the wrong foot or the wrong kidney removed or the wrong level of spinal disc operation.

KNOX: Just this week, New Jersey authorities suspended one surgeon's license after he removed the wrong lung from a patient, then tried to conceal the mistake. The new WHO checklist has 22 items over three stages, before, during, and after an operation. Among other things, people on the team have to verify if they're about to operate on the right patient with the right procedure in the right place, if a patient has allergies, if the patient may need blood, if he's had pre-op antibiotics, if at the end there are any instruments or sponges unaccounted for, they might be inside the patient. The WHO tapped Dr. Atul Gawande to head an international task force to devise the checklist. Gawande is a Boston surgeon and a professor at the Harvard School of Public Health who writes frequently about how things go wrong in medicine. He says it's important that the checklist is verbal, not on paper.

Dr. ATUL GAWANDE (Surgeon, Professor at Harvard School of Public Health): There's actually been good studies from the nuclear power industry that people are more than 10 times more likely to avoid missing a step when they have to verbally confirm with somebody else that they met that step, rather than just check it off on a piece of paper

KNOX: Because it's public?

Dr. GAWANDE: Because it's public.

KNOX: Eight medical centers around the world have been using the surgical checklist. At the start, they were doing everything they should only a third of the time. A thousand operations later, that improved to two-thirds of the time. There's been resistance. One London surgeon thought it was demeaning Mickey Mouse stuff until one day…

Dr. GAWANDE: Right before the incision, they took the timeout. 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?

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

Richard Knox, NPR News.

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