The Albuquerque Journal recently reported on a surgical checklist proposed by the World Health Organization to reduce operating room errors.
The contents on the list are pretty simple including pre-surgical procedures for verifying the surgical procedure with the surgical team, verifying the identity of the patient before beginning surgery, marking the surgical site with a pen or marker, verifying patient allergies, verifying that all necessary equipment is in the operating room and working properly, verifying all necessary x-rays and other images are in the operating room and at the end of surgery, making sure that all equipment and supplies are accounted for to avoid the embarrassing and often very serious oversight of leaving stuff inside the patient.
The New England Journal of Medicine reported that the checklist was effective in the 8 cities around the world that utilized the list and in those hospitals using the list, post-operative complications, including deaths, fell by 36 percent. The World Health Organization found that inpatient deaths following major operations fell by more than 40%. The Albuquerque Journal reported that Presbyterian Kaseman Hospital alone expects to save 162 lives this year using a version of the checklist.
Oddly, the authors of the New England Journal of Medicine study indicated “Whereas the evidence of improvement in surgical outcomes is substantial and robust, the exact mechanism of improvement is less clear and most likely multifactorial.” Most people would go the other direction asking why in the world there has been no such checklist in the past. Most people, including those patients and their families that undergo 234 million surgical procedures each year around the world, probably assumed that there was and always has been such a checklist. People make checklists when they go to the grocery store. Is it really too much to ask that surgical teams exercise the same level of planning?
This report is disturbing on many levels. Is it really to be viewed as a medical breakthrough of sorts that surgical staff would begin to verify the patient, procedure and surgical site prior to operating? It is remarkable that Presbyterian Kaseman, according the Albuquerque Journal, expects to save 162 lives this year through implementation of the checklist. Most would consider failure to perform these basic tasks to be negligent, arguably grossly negligent. And one would be justified in asking, “If 162 lives can be saved through these simple procedures this year, what about those 162 lives lost last year and the year before as result of the failure to implement these seemingly obvious surgical procedures?”
These reports come out in the midst of ongoing Tort Reform battles to limit or bar medical malpractice lawsuits, continued movement for limits on medical malpractice claims, and generally growing and expensive obstacles to such claims by injured patients or their survivors. When hearing this report, the rather unbelievable assertion by the Institute of Medicine that up to 98,000 patients die each year in the United States as a result of medical negligence makes perfect sense. It would also tend to make any reasonable patient nervous about any surgical procedure knowing that very few hospitals have implemented the checklist and that Tort Reformers and medical industry lobbyist are hard at work to limit claims by a patient in the event that he or she is among that 98,000 next year.