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Surgeon's Checklist Saves Lives
Date:1/14/2009

nal of Medicine.

To test the validity of the checklist, Gawande's team collected data on 7,688 patients. They collected data on 3,733 patients before using the checklist and on 3,955 patients after surgeons started using the checklist.

During the year of the study, the rate of major complications in operating rooms dropped by more than a third when the checklist was used -- from 11 percent to 7 percent.

More importantly, deaths dropped by more than 40 percent when the checklist was introduced, from 1.5 percent to 0.8 percent, the researchers found.

The value of the checklist was seen in hospitals worldwide, with similar reductions in death and complications. The checklist was used in hospitals in: Seattle; Toronto; London; Auckland, New Zealand; Amman, Jordan; New Delhi, India; Manila, Philippines; and Ifakara, Tanzania.

"I have been using the checklist for a year, and I don't get through a week when we don't catch something. Often they are small things, but I've seen it save the life of a patient," Gawande said.

Gawande noted that the checklist is being adopted by hospital associations in five states including Washington, North Carolina, South Carolina, Indiana and New York. In addition, the U.K., the Philippines, Ireland and Jordan plan to adopt the checklist nationwide, he said.

Dr. Jeffrey Salomon, an assistant professor, surgery at Yale University School of Medicine, noted that many surgeons are starting to use a form of checklist.

"The 'timeout' is mandated in surgery in this country since Medicare indicated that it would not reimburse for a variety of errors such as wrong-side surgery," Salomon said.

"It initially seemed a little juvenile to surgeons, but has come to be well-accepted by all operating room personnel," he said. "There is little question that it helps reduce avoidable errors, just like an airplane pilot has a checklist to reduce the same."


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