Should Australian hospitals be required to implement the WHO Surgical Safety Checklist which has been shown to reduce post operative deaths and complications?
The UK National Patient Safety Agency has issued an alert requiring all healthcare organisations in England and Wales to implement the checklist (adapted for England and Wales) for every patient undergoing a surgical procedure by 1 February 2010.
Mary Haines, Health Services Research Director of the Sax Institute, reports in her latest bulletin that there is evidence that at least half of the complications associated with surgery are avoidable.
She cites a recent study, published in the New England Journal of Medicine, comparing the rate of complications and death prior to and after the implementation of the WHO’s 19 point surgical safety checklist in 8 hospitals around the world.
Postoperative complication rates fell at all sites after the introduction of the checklist, on average by 36%. The total in-hospital rate of death fell from 1.5% to 0.8%.
Perhaps some Australian hospitals are already implementing the checklist or similar.
But if they’re not, and if there is good evidence that such a relatively simple step could save lives and prevent suffering, then who should be held accountable? Surgeons? Hospital bosses? Bureaucrats? Health funds?
In the meantime, it might be sensible for patients to ask if their surgeon uses the checklist…
2 Comments
The Royal Australiasian College of Surgeons implemented mandatory “Time Out” for all surgery about 8 years ago. (Indeed it has been so long since it was mandated that I cannot find the original correspondence.) Both public and private hospitals need to demonstrate more than 90% time out compliance to be accredited with the Australian Council on Healthcare Standards. The check in and check out processes that make up part of the WHO Checklist have been mandated processes for all surgery for at least 20 years (as long as I have been a doctor).
What the NHJM paper demonstrates is that we haven’t all been wasting our time doing the extra paper work.
The Australian Public should be reassured that between the ACHS and the RACS we have the most up to date, and exhaustive set of surgical standards on the planet.
There is certainly strong evidence that the use of clinical protocols (including checklists) can improve the quality and safety of care, and it makes sense that compelling health professionals to make use of evidence through such mechanisms should be occurring. Far too little has been done in Australia by all stakeholders (professional bodies, administrators, bureaucrats, politicians, governments) to address the appalling rate of adverse events that occur, not only in Australian hospitals, but other health care settings too. All should be targets of quality and safety interventions. There is also evidence that incident reporting is higher where protocols exist – another important weapon in the quality and safety toolbox. These and other measures should be employed such as comparative effectiveness research (CER). Sadly the public assume that the interventions they are the recipients of will be based on the best available evidence and that their care is tailored such that the care they receive is actually proven to be the most effective. Of course it is also possible to make cost based decisions using CER, and while there will be concerns about that, it is all part of the transparency and accountability we should be seeing in health care. We will all (as taxpayers, and consumers of health care) be better for it.