Safety Checklist 'Reduced Post-Surgery Deaths by a Third'

Peter Russell

April 22, 2019

Deaths following surgery in Scotland dropped by more than a third over a 10-year period, research found.

A study in the BJS (British Journal of Surgery) found a 36.6% relative reduction in perioperative mortality since the implementation from 2008 of a surgical safety checklist in Scotland.

The checklist was created by the World Health Organisation (WHO) over a decade ago. Its aim was to make surgical procedures safer by ensuring adherence to established practices and creating a culture of communication and teamwork.

The WHO has said that the 19-item checklist has gone on to show significant reductions in morbidity and mortality.

The research team, led by The Rowett Institute, University of Aberdeen, set out to compare the number of deaths before and after the checklist was introduced.

Analysing Data From Scotland's Hospitals

It involved an analysis of data from almost 12.7 million hospital admissions, of which more than 6.8 million involved a surgical procedure.

All admissions to any acute hospital in Scotland between 2000 and 2014 were included.

The researchers found that the morality rate declined from 0.76 per 100 surgical procedures in 2000 to 0.46 in 2014.

The fall in death rates was seen only in patients who had surgery, and not in patients undergoing other treatments for medical conditions during this time frame.

The study authors point out that the surgical checklist was not a stand-alone intervention, and was additional to 10 patient safety essentials implemented by health boards in Scotland.

However, they said it was the only item on the 'essentials' list that targeted surgical patients specifically during the period studied.

"This study provides further evidence that the success of checklist implementation is more pronounced when it is supported by a cohesive and wider approach to patient safety," the authors concluded.

'Some of the Largest Reductions Ever Documented'

US surgeon Dr Atul Gawande, who led the introduction of the Surgical Safety Checklist, and co-authored the study, said: "Scotland's health system is to be congratulated for a multi-year effort that has produced some of the largest population-wide reductions in surgical deaths ever documented."

Jason Leitch, Scotland's National Clinical Director, said: "This is a significant study that highlights the reduction in surgical mortality over the last decade.

"While there are a number of factors that have contributed to this, it is clear from the research that the introduction of the WHO's Surgical Safety Checklist in 2008 has played a key role.

"This decline in mortality has been achieved through the hard work of hundreds of people involved in the project across the NHS in Scotland, delivered under the Scottish Patient Safety Programme alongside a number of other surgical safety measures."

Reducing surgical mortality in Scotland by use of the WHO Surgical Safety Checklist, Ramsay G et al, BJS. Paper .

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