Wednesday, June 25, 2008
The New York Times reports on the adoption by the WHO of a series of checklists to help reduce injuries and deaths during surgery. Lawrence Altman writes,
The World Health Organization issued its first guidelines on Tuesday aimed at reducing complications and deaths from the rising numbers of operations now being performed. The guidelines are a list of simple safety checks that the health organization said could halve the rate of surgical complications. The list is intended to improve anesthetic safety practices, avoid infections and improve communication among members of surgical teams. For example, one guideline calls for all members of the masked surgical team to identify themselves and their roles and ask simple questions like, “Does everyone agree that this is Patient X, undergoing a hernia repair?”
Other recommendations call for marking the correct site for surgery to avoid operating on the wrong patient or performing the wrong procedure; giving an antibiotic within 60 minutes of making an incision, to reduce infections; checking for allergies to drugs; inserting two intravenous lines for operations involving substantial blood loss; and counting sponges and needles to ensure that none are left in a patient.
Dr. E. Patchen Dellinger, vice chairman of surgery at the University of Washington, which took part in the W.H.O. research, said that when the checklist was discussed with nonmedical people, “the most common reaction is the question: ‘You mean you haven’t been doing this all along?’ ”
The surgical guidelines grew out of a similar checklist aimed at reducing infections in hospitals. The infection guidelines were developed by Dr. Peter J. Pronovost of Johns Hopkins University, who borrowed the idea from the aviation industry, said Dr. Atul Gawande, of the Harvard School of Public Health. Dr. Gawande and his team at Harvard had been asked by the W.H.O. to develop a method to reduce surgical deaths, and he said they used the infection guidelines as a model.
Three countries — Britain, Ireland and Jordan — have said they will put the surgery guidelines in force in all hospitals, Dr. Gawande said. Professional groups endorsing checklists include the American College of Surgeons, the American Society of Anesthesiology and the Association of Perioperative Registered Nurses. . . .
These checklists seem to be overdue and hopefully the fear that such helpful lists will create a standard for liability will not deter others from adopting such lists for their practices.