Surgical Checklists Save Lives: Help Prevent Medical Malpractice Claims
Medical malpractice can happen in a variety of ways. Often there are simple steps that can be taken to reduce or eliminate the chance that patients may suffer an injury (or worse) due to malpractice.
Reduces Errors
I have posted before about how using surgical checklists helps reduce medical errors and prevents deaths due to surgical errors.
Reduces Deaths
Now a new research study conducted in American Veterans Affairs Hospitals has shown that surgery deaths dropped by as much as 18% in hospitals that used surgical checklists.
The study involved results from almost 200,000 surgeries performed at 74 hospitals over 3 years. In hospitals that did not use the checklist there was no change in the number of surgical deaths. The results of the study have been published in the Journal of the American Medical Association.
Everything Old is New Again
The use of surgical checklists as a means to prevent medical malpractice, surgical errors and deaths is not new but it does appear to be receiving renewed interest by health care providers.
CMPA Advocates Use of Surgical Checklists
Here in Canada, the Canadian Medical Protective Association advocates the use of surgical checklists. The September issue of the Canadian Medical Protective Association Journal contains an article identifying a number of sources of medical errors which can be eliminated or reduced through the use of surgical checklists:
Patient related issues:
• Inadequate confirmation of informed consent, the nature of the planned medical procedure, failure to properly identify the site of the surgery and failure to display relevant imaging studies (x-rays and ct scans etc.) often leading to wrong site surgery.
• Absence of a timely review of a patient’s history and medical test results (which may result in the doctor overlooking or not being aware of factors that may increase the patient’s risk).
• Issues with respect to allergy status, the availability of blood products and patient positioning during surgery.
Medication issues:
• Failing to administer prophylactic antibiotics before surgery.
• Failing to consider the need for venous thromboembolic prophylaxis.
• Failing to properly check anesthesia being used during procedures.
Equipment Issues:
• Failing to confirm that equipment used in the surgery is functioning properly.
• Inadequate anesthesia safety equipment (turning off or disabling monitors/alarms).
Is Not Using a Checklist Negligent?
The use of surgical checklists is still not standard practice in hospitals across Canada. Some hospitals and doctors use them, some do not.
It is clear that using a checklist can help reduce or prevent negligence.
Given the overwheming evidence that using surgical checklists reduces morbidity (injury) and mortality (death) one has to ask the question: "Is the decision not to use a surgical checklist negligent?"
If a pilot takes off without going through the standard pre-flight checklist, I think we would all agree the pilot was negligent. If a doctor performs surgery without going through a standard checklist is the doctor negligent?
What do you think?
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