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Simple Checklist from the World Health Organization Reduces Accidental Surgery Deaths

A World Health Organization (WHO) team has published a study indicating that implementing a simple surgery safety checklist at hospitals would greatly reduce accidental deaths during surgery. The 19-item surgical safety checklist was designed by the WHO to improve team communication and consistency of care in order to reduce complications and deaths associated with surgery.

The team implemented the checklist at eight hospitals, four of which were in high-income nations, while the other four were in low- or middle-income countries. The study showed a significant decrease in the death rate from 1.5 percent before the checklist was introduced to 0.8 percent afterward. The results were dramatic in the lower income nations, while less so in the high-income nations, but the AP reports that countries encompassing the entire spectrum are implementing the checklist such as Ireland, Jordan, the Philippines and Britain. In the United States, the Joint Commission, which accredits and sets standards for hospitals, is considering adopting more of the steps too.

Although hospitals' initial concern might be how costly or time intensive implementing the checklist might be, the study indicated that all of the sites were able to introduce the checklist in a fairly short period of time and that only two of the safety measures in the checklist are relatively costly. Furthermore, hospitals here in the United States could look at the checklist as a cost-saving measure in terms of avoiding medical malpractice cases.

Accidental injuries and deaths from surgery, which we often hear about in the news when a surgical tool or sponge is left behind in a patient, are a major source of medical malpractice cases in the country. As a quick refresher, to establish medical negligence, a patient must establish:

1) They were injured;

2) The existence of a duty owed by the health care professional to the plaintiff (i.e., a doctor/patient relationship);

3) The applicable standard of care, and the health care professional's deviation from that standard;

4) A causal relationship between the professional's deviation from the standard of care and the patient's injury.

Once these are established, the injured patient must prove their "damages". Some damages, such as hospital bills or the costs of future care, might not be too difficult to quantify, but on the other hand, other costs to the victim can be difficult, if not impossible to put a value on. After all, how many people would be able to put a fair price on their overall health, on time lost in recovery, or on pain and suffering?

For this reason, sometimes victims in medical malpractice suits do not end up feeling that they've been "made whole" by a lawsuit and the money they end up with. Indeed, it's probably safe to assume that all parties involved in such cases would prefer to prevent the accidental injuries in the first place. If hospitals begin to implement the safety checklist, that could turn out be a fast and relatively inexpensive step towards valuable prevention.

• Reuters: Simple checklist cuts accidental deaths in surgery
• AP: Study: Basic checklist cut surgical deaths in half
• The Study on Implementing the Checklist (The New England Journal of Medicine)
• WHO Surgical Safety Checklist (WHO)
• Checklist Implementation Manual (WHO)
• Local10.com: Woman Gets $2.4 Million After Sponge Left In Body
• Medical Malpractice - Overview (FindLaw)
• Proving Fault in Medical Malpractice Cases (FindLaw)
• Damages in Medical Malpractice Cases (provided by Tooher & Wocl, L.L.C.)

Full post as published by FindLaw's Common Law on January 15, 2009 (boomark / email).