Checklists Help Improve Medical Care: Is your hospital using one?

by John McKiggan

Surgical Infections a Huge Problem

It’s not news that surgeries can result in infections.

More than 250,000 patients develop infections in hospitals across Canada every year. 8000 to 9000 patients will die from the infections they develop in the hospital.

According to a report from the CBC, Hospital acquired infections kill more Canadians every year than AIDS, breast cancer and car accident combined.

In addition to the cost in human lives, there is a significant financial cost to fighting hospital infections.

For example, the California Department of Public Health reports that surgical site infections are the second most common type of hospital acquired infection with approximately 290,000 infections per year. This is estimated to cost between 3.5 and 10 billion dollars per year.

Simple Steps = Big Risk Reduction

But there is good news coming out of a recent study involving seven big hospitals in the United States. The project-study resulted in a one-third reduction in infections following colorectal surgeries. This amounts to a reduction of approximately 135 infections – or $4 million in costs.

The Hospitals that participated in the study made 3 simple changes to hospital policy that resulted in a 30% decrease in the rate of post surgery infections.

3 Simple Changes

Three changes were made at the hospitals:

(1) Patients were made to shower with a special germ-fighting soap prior to surgery;

(2) Surgery teams were made to change gowns, gloves and instruments during the operations; and,

(3) Special wound-protecting devices were used on surgery openings to prevent intestine germs from contacting skin.

In addition to decreasing the rate of infections, the Hospital found that patients who did suffer infections recovered faster, 13 days instead of 15 days.

The President of the commission responsible for the study, Dr. Mark Chassin says:

“The improvements translate into safer patient care. Now it’s our job to spread these effective interventions to all hospitals.”

Surgical Checklist Improves Patient Care

I have written about the dangers of surgery and simple ways hospital staff can reduce errors in a previous article: Simple Checklist Helps Prevent Deaths and Complications after Surgery

The surgical checklist requires the operating team to review a list of questions including:

1. Were proper antibiotics administered?;

2. Is the correct patient on the operating table?;

3. Is the correct surgical site identified?;

4. Is sufficient anesthesia and blood supply available?;

5. Does the patient have any allergies?;

6. Were the needles/sponges correctly counted to make sure nothing was left inside the patient?

Considering the results of the US study, maybe there should be a few more sections added to this checklist. If the steps listed above can substantially reduce the rate of surgical infections, surely there should be widespread implementation.

The Checklist Manifesto

Writing this article reminded me of a fascinating book I read a while ago, The Checklist Manifesto by Dr. Atul Gawande. The book explores the power and value of standardizing procedures through the use of checklists. As dry as that sounds, the book is actually an entertaining and educational read.

Dr. Gawande starts with his own experience in seeing how using surgical checklists improves patient outcome then expands his investigation into how using checklists can help each of us become better at what we do.

What do you think?

What do you think? Should checklists be standard practice in hospitals now?

Let me know by leaving a comment.

Comments are closed.