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Hospital Checklists Reduce Surgical Complications, Deaths: Study
Date:11/11/2010

report occurred due to simple errors in judgment or because surgical teams had failed to perform standard pre-operation checks.

To reduce errors, hospitals are increasingly turning to checklists -- and a growing body of research shows they work.

A study in the Oct. 20 issue of the Journal of the American Medical Association found that a program at 108 Veterans Administration hospitals that involved pre- and post-surgical debriefings as well as checklists reduced deaths by 18 percent.

In the new study, all participating hospitals, which included both academic and teaching hospitals, were highly regarded before implementation of the checklists, showing that even high-performing hospitals can benefit, Boermeester noted.

After implementing the checklists, complications fell from 27.3 per 100 patients to 16.7 per 100. The proportion of patients with one or more complications fell from 15.4 percent to 10.6 percent, while the in-hospital death rate fell from 1.5 percent to 0.8 percent.

Patient outcomes did not change at hospitals used as controls.

Dr. John Birkmeyer, a surgeon and director of the Center for Healthcare Outcomes and Policy at the University of Michigan, said the study provides strong evidence that checklists aren't merely a good idea, but something that all hospitals should be using as a "best practice."

"This study confirms previous research that showed the use of checklists can have a dramatic effect in both reducing the risk of dying after surgery and suffering other types of complications," Birkmeyer said. "There is enough evidence that has accrued about the effectiveness of checklists that I believe they have crossed a threshold beyond just being a good idea and to becoming a standard of surgical care."

Not only did the checklists reduce the specific complications targeted by line items on the checklist (such as having blood available or giving the right antibiotics before surgery), but they
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