According to a new study published in the New England Journal of Medicine, when surgical teams performed a simple checklist prior to surgery, patient morality rates were cut nearly in half and complications fell by more than a third.
The study involved 7,688 patients in 8 hospitals around the globe and reported that death rates declined from 1.5% before the checklist was instituted to 0.8% afterwards. Serious complications fell from 11% to 7%.
The checklist was comprised of nineteen tasks to be performed throughout the surgery - seven before anesthetizing the patient, seven just before the first incision, and five before the patient leaves the operating room. Basic safety tasks, such as whether enough blood was available in case of bleeding, made up another six items on the checklist.
Doctors disagree on what the results of this study mean. Some are skeptical and characterize the behavioral change as "trivial," while others think that the net effect makes for more effective teamwork which can help save lives. Whether the changes can be sustained over time, however, is another question. A phenomenon known as the "Hawthorne effect" may be largely responsible for the checklist's success. The Hawthorne effect was named for a series of experiments designed to determine how to increase productivity in a factory in Chicago. All of the tactics implemented improved worker output during the experiment, but researchers realized that the effect they were really measuring was a boost in motivation among workers who knew they were being watched. With this most recent surgery checklist, however, researchers checked whether teams behaved differently when the researchers were present and when they were not and luckily found no difference.
As a result of the study findings, the U.K's national Health Service sent out an alert to all of its hospitals, calling on them to implement the surgical checklist. Five U.S. states (New York, Washington, North Carolina, South Carolina and Indiana) have endorsed it and plan to require hospitals to use it. We will hopefully see Illinois follow suit in the near future.