WHO issues a checklist to make operations safer

[Guest guest]

WHO issues a checklist to make operations safer

By Lawrence K. Altman Published: June 26, 2008

The World Health Organization issued its first guidelines on Tuesday

aimed at reducing complications and deaths from the rising numbers of

operations now being performed.

The guidelines are a list of simple safety checks that the health

organization said could halve the rate of surgical complications. The

list is intended to improve anesthetic safety practices, avoid

infections and improve communication among members of surgical teams.

For example, one guideline calls for all members of the masked

surgical team to identify themselves and their roles and ask simple

questions like, " Does everyone agree that this is Patient X,

undergoing a hernia repair? "

Other recommendations call for marking the correct site for surgery to

avoid operating on the wrong patient or performing the wrong

procedure; giving an antibiotic within 60 minutes of making an

incision, to reduce infections; checking for allergies to drugs;

inserting two intravenous lines for operations involving substantial

blood loss; and counting sponges and needles to ensure that none are

left in a patient.

Dr. E. Patchen Dellinger, vice chairman of surgery at the University

of Washington, which took part in the WHO research, said that when the

checklist was discussed with nonmedical people, " the most common

reaction is the question: 'You mean you haven't been doing this all

along?' "

The surgical guidelines grew out of a similar checklist aimed at

reducing infections in hospitals. The infection guidelines were

developed by Dr. Pronovost of s Hopkins University, who

borrowed the idea from the aviation industry, said Dr. Atul Gawande,

of the Harvard School of Public Health.

Gawande and his team at Harvard had been asked by the WHO to develop a

method to reduce surgical deaths, and he said they used the infection

guidelines as a model.

Three countries — Britain, Ireland and Jordan — have said they will

put the surgery guidelines in force in all hospitals, Gawande said.

Professional groups endorsing checklists include the American College

of Surgeons, the American Society of Anesthesiology and the

Association of Perioperative Registered Nurses.

To develop the guidelines, the Harvard team did two studies with WHO.

Using surgical data from more than one-fourth of the organization's

192 member states, Gawande's team estimated that 234 million major

surgical procedures were undertaken each year worldwide. Of the total,

172 million, or 74 percent, were in the wealthier countries, and 40

million of those were in the United States.

The number of surgical procedures performed in a year is nearly double

the number of births " and is probably an order of magnitude more

dangerous, " Gawande's team reported in an article in the journal

Lancet, which was released on Tuesday.

The team also conducted a pilot study involving 3,600 patients in

eight hospitals in poor and rich countries to determine whether using

a checklist could help reduce surgical complication rates.

Data from the first 1,000 patients, which is expected to be reported

at a meeting in Washington on Wednesday, showed that the use of a

checklist increased adherence to standards of care to 68 percent from

36 percent, and approached 100 percent in some hospitals. Final

results are expected later this year.

Some sites in richer countries did worse than ones in poorer

countries, Gawande said. The researchers and hospitals agreed not to

disclose specific data from individual institutions.

The hospitals included the University of Washington in Seattle; the

University of Toronto; St. 's Hospital in London; the University

of Auckland in New Zealand; Philippine General Hospital in Manila;

Prince Hamza Hospital in Amman, Jordan; St. 's Hospital in New

Delhi; and the District Hospital in Ifakara, Tanzania.

Creating an accurate, functional checklist for surgery took many

revisions, Gawande said, adding: " You can make bad checklists and you

can make good checklists. It is very easy to make a bad checklist that

people want to throw away and never use. "

http://www.iht.com/articles/2008/06/26/healthscience/25surgery.php