Operation Checklist Issued by W.H.O.

Author: Allie Montgomery

The World Health Organization recently issued it first guidelines on surgical safety in the form of a checklist. They aim to reduce the amount of complications and deaths from the rising numbers of operations now being performed.

The main guidelines are simple safety checks that health organizations said could half the rate of complications during surgeries. The checklist is intended to improve anesthetic safety practices, improve the communication among the members of surgical teams, and avoid infections.

Here is an example of how the guidelines work: one of the guidelines calls for all of the members of the surgical team to identify themselves and their roles in the surgery and ask simple questions like: Does everyone agree that this is Patient X, undergoing knee surgery? Other recommendations call for marking the correct site for the surgery to avoid operating on the wrong patient or performing the wrong procedure on the patient, checking the patient for drug allergies, giving the patient an antibiotic within 60 minutes of making the first incision, counting the sponges and needles to make sure none are left in the patient after surgery, and inserting two intravenous lines for operations that will involve substantial blood loss.

The vice chairman of surgery at the University of Washington, Dr. E. Patchen Dellinger took part in the W.H.O. research, and said that when they discussed the checklist with non-medical people, "The most common reaction is the question: ‘You mean you haven't been doing this all along?'"

The surgical guidelines came from a similar checklist that was aimed at reducing infections in hospitals, developed by Dr. Peter J. Pronovost of Johns Hopkins University. Dr. Atul Gawade of the Harvard School of Public Health said that he borrowed the idea from the industry of aviation. Dr. Gawade and his team at Harvard were asked by the World Health Organization to develop a method to reduce death caused by surgery, and he said they used the infection guidelines as a model. He also said that Britain, Jordan, and Ireland would put the surgery guidelines in force in all hospitals. The professional groups that are endorsing the checklist include the American Society of Anesthesiology, the Association of Perioperative Registered Nurses, and the American College of Surgeons.

To develop the guidelines for the checklist, the team at Harvard did two studies with W.H.O. Dr. Gawade's team used surgical data from more than one-fourth of the organization's 192 members states and estimated that 234 million surgical procedures were undertaken worldwide every year. Of all the 172 million, they were in the weather countries, and 40 million of those surgeries were in the United States.

According to Dr. Gwanade's team, as they reported in an article in the journal Lancet, the number of surgical procedures performed in one year is nearly double the number of babies being born "and is probably an order of magnitude more dangerous."

Gwande's team also conducted a pilot study that involved 3,600 patients in eight hospitals in rich and poor countries to determine whether using this new checklist could help reduce surgical complication rates. The data from the first 1,000 patients, which is expected to be told at a meeting in Washington, showed that the use of the checklist increased adherence to the standards of care from 36 percent to 68 percent, and approached 100 percent in some hospitals. The final results are expected to be known later this year.

Believe it or not, some sites in the richer countries did worse that the ones in poorer countries, according to Dr.Gawande. The researchers and hospitals both agreed not to disclose data that was specific from the individual institutions.

The hospitals in this study included, St. Mary's Hospital in London, the University of Washington in Seattle, the University of Auckland in New Zealand, The University of Toronto, Philippine General Hospital in Manila, St. Stephen's Hospital in New Delhi, Prince Hamza Hospital in Amman, the District in Ifakara, Tanzania.

Creating a functional and accurate checklist for surgery took many revisions, Dr. Gawande said. He also added that, "You 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."