Checklists can cut surgical complications

For more than 60 years surgeons said surgical crises were too complex for simple checklists to be helpful, but they have been proven wrong, a U.S. expert says. "For decades, we in surgery believed surgical crisis situations were too complex for simple checklists to be helpful. This work showed that assumption was wrong," senior author Dr. Atul Gawande, a surgeon at Brigham and Women's Hospital and professor at the Harvard School of Public Health, said in a statement. "Four years ago, we showed completing a routine checklist before surgery could substantially reduce the likelihood of a major complication. This new work showed use of a set of carefully crafted checklists during an operating room crisis also has the potential to markedly improve care and safety." For the randomized-controlled trial, investigators simulated multiple operating room crises and assessed the ability of 17 operating room teams from three Boston area hospitals to adhere to life-saving steps for each simulated crisis. In half of the crisis scenarios, operating room teams were provided with evidence-based, written checklists. In the other half of crisis scenarios, the teams worked from memory alone. The study, published in the New England Journal of Medicine, found if a checklist was used during a surgical crisis, teams were able to reduce the chances of missing a life-saving step by nearly 75 percent. Checklists were first used by military pilots almost 80 years ago and they were later adopted by high-risk industries such nuclear power plants where they were shown to improve performance during unpredictable crisis events, Gawande said.