Surgeons: it's as simple as a checklist

Researchers have confirmed two simple cost-effective methods to reduce expensive postoperative complications -- communications team training and a surgical checklist. Investigators found that when surgical teams completed communications training and a surgical procedure checklist before, during, and after high-risk operations, patients experienced fewer adverse events such as infections and blood clots. The study is published in the December issue of the Journal of the American College of Surgeons.

Although surgical checklists have existed for a while, they are not universally used. The study compared three groups of surgical procedures to determine whether communications training coupled with a standardized checklist could bring surgical teams into agreement and reduce patients' complications.

Study results showed that the communications training coupled with the checklist curbed complications within 30 days of the procedures. Complications included surgical site infections, vein blood clots, lung blood clots, and urinary tract infections. When surgical teams had no communications training and did not use checklist, more than 23 percent of the procedures resulted in complications within 30 days. About 16 percent of procedures by surgical teams who only participated in communications training led to complications within 30 days, and only 8.2 percent of the procedures had a 30-day complication when the surgical teams used both the communications training and the checklist.

Even small steps like making sure everyone on the team introduced themselves before the procedure helped reduce complications. The drop in postoperative complications also has implications for national health care spending because Medicare and other health insurance providers are now starting to decline reimbursement for complications that result from the clinicians' errors, especially just a month after the patient's procedure. The authors note that postoperative infections are among the most expensive medical errors, costing $14,500 per case on average.