The Checklist Effect
Since the release of the Checklist in June 2008, thousands of hospitals have started using the Checklist in their operating theatres. Below are anecdotal stories and data that hospitals have released demonstrating that the Checklist has made a difference in their operating theatres.
The WHO Surgical Safety Checklist reduced the rate of deaths and complications by more than one third in our eight pilot hospitals. The rate of major inpatient complications dropped from 11% to 7%, and the inpatient death rate following major operations fell from 1.5% to 0.8% after implementation of the checklist. The effect was of similar magnitude in both high and low/middle income country sites. The full text of the paper is available free of charge as an Online First publication here.
Use of a comprehensive surgical safety checklist and implementation of a structured team training curriculum produced a statistically significant decrease in 30-day morbidity. Adoption of a comprehensive checklist is feasible with team training intervention and can produce measurable improvements in patient outcomes. To review the abstract, please click here.
Deutsches Ärzteblatt International is the German Medical Association's official international bilingual science journal. This article analyzes 20 articles that were written about the WHO Surgical Safety Checklist. Based on their analysis the authors concluded that the checklist should be understood not merely as a list of items to be checked off, but as an instrument for the improvement of communication, teamwork, and safety culture in the operating room, and it should be implemented accordingly.
To review this articles, please click here.
To review this articles, please click here.
This article out of the Netherlands was a retrospective cohort study of adult patients undergoing non-day case surgery in a tertiary university hospital. After checklist implementation, crude mortality decreased from 3.13% to 2.85% (P = 0.19). Implementation of the WHO Surgical Checklist reduced in-hospital 30-day mortality. This effect was strongly related to checklist compliance. To review the abstract, please click here.
Safer surgery: how a checklist can make orthopaedic surgery safer is an article that focuses on the importance of surgical safety checklists in orthopaedic surgery. It focuses on the importance of better teamwork and communication in operating theatres. Teamwork is definable and measurable and can be improved through formal structured communication, such as checklists. To review the abstract, please click here.
SURPASS Checklist, Netherlands
Researchers in the Netherlands developed a 100-item checklist that spans the surgical pathway, including checks that address medications, marking of the correct operative site, and ensuring that the team discusses post-operative instructions. Compared to controls, the six test hospitals had a greater than one-third reduction in complications and achieved an almost 50% reduction in deaths. To learn more about the findings that were published in the New England Journal of Medicine, please click here.
Dr. John Birkmeyer Editorial, New England Journal of Medicine
Dr. John Birkmeyer discusses the use of checklists in the operating room and beyond in the November 2010 edition of the New England Journal of Medicine. To read Dr. Berkmeyer's editorial please click here.
Veterans Health Administration, United States
The Veteran's Health Administration (VHA) implemented a formalized team training program in 74 of their facilities that included the use of a surgical safety checklist. The hospitals that participated in this program experienced an 18% reduction in mortality. Click here to learn more about the results that were published in the Journal of the American Medical Association.
A study at Children's Hospital in Boston observed the implementation of a surgical safety checklist modified for a pediatric population. Results of the pilot test showed improvements in teamwork, communication, and adherence to process measures. An abstract from this study is available here.
A study at the Virginia Mason Medical Center in Seattle, Washington observed the effectiveness of the checklist in improving team building. The results and discussion offer insight into changing the hierarchical culture of the operating room. An abstract from this study is available here.
Region Zealand, Hospital South - Naestved, Denmark
The departments of Surgery and Anesthesiology at Region Zealand, Hospital South recently published a poster highlighting the effect that the WHO's Surgical Safety Checklist has had in their hospital. They reported a 35% reduction in mortality. To learn more about these results click here.
Private Hatwan Hospital - Kurdistan, Iraq
Private Hatwan Hospital in Kurdistan, Iraq experienced a significant reduction in their complication rate and found that the WHO Surgical Safety Checklist increased compliance with the administration of prophylactic antibiotics and site marking for Endoscopic procedures. To see these results click here.
University Hospital - Monastir, Tunisia
Researchers at Tunisia’s University Hospital of Monastir led a study to measure the effect of the WHO Surgical Safety Checklist in their Pediatric Surgery Department. Find out more about how they developed the study as well as their results by clicking here.
The National Patient Safety Agency - Wales, United Kingdom
The use of the Checklist has now spread to every hospital in Wales that performs surgical procedures. Since the Checklist was implemented at a national scale, they have experienced increased compliance with the appropriate timing of antibiotic administration and verification of the patient’s name, procedure, and where the incision will be made. To see the how the Checklist affected surgical care in Wales click here.
University Health Network Toronto General Hospital - Toronto, Canada
See how the Checklist has impacted care at University Health Network's Toronto General Hospital. Although they first started using the Surgical Safety Checklist in 2008, when they served as one of the eight pilot sites for our efficacy study, they have since incorporated it into their standard of care. To learn more about UHN and its role in our pilot study, please click here.
Great Ormand Street Hospital - London, United Kingdom
The Great Ormond Street Hospital NHS Trust published a video on the value of the WHO Surgical Safety Checklist. Click here to view larger.
A comprehensive bibliographical record of checklist evidence and related articles. To download click here.