Make a List and Check It Twice

Back in August 2008, we blogged about the somewhat alarming increase in medical “never events”–serious medical errors, such as leaving surgical instruments inside patients or giving patients the wrong medication. Well, it now appears many of those medical errors, in particular surgical errors, can be avoided. In January 2009 the New England Journal of Medicine published the results of an international study in which surgical teams simply followed a checklist of steps before, during, and after surgery. By following the 19-item checklist, the number of surgical deaths decreased by almost half, and complications were cut by more than a third.

The checklist was implemented in eight major cities in eight countries from 2007 to 2008. These cities included Seattle, Washington; Toronto, Canada; London; New Delhi; Auckland, New Zealand; Amman, Jordan; Manila, Philippines; and Ifakara, Tanzania. The checklist was most effective in preventing deaths in developing countries.

Researchers believe that if U.S. hospitals adopted a similar checklist, some $15 billion per year could be saved.

The checklist, created by the World Health Organization, included such things as marking on the body to indicate where any incisions will be made (before anesthesia, so the patient is aware of the markings), making sure each person in the operating room is aware of everyone’s duties, and counting all surgical instruments, sponges, and other items after surgery to make sure they are all accounted for.