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2 mins that could alter Indian surgery

A simple surgical checklist used during major operations lowered surgery-related complications and death by 40 per cent in eight hospitals across the world, including in India, reported the New England Journal of Medicine. Sanchita Sharma elaborates.

health and fitness Updated: Jan 17, 2009 02:12 IST
Sanchita Sharma

A simple surgical checklist used during major operations lowered surgery-related complications and death by 40 per cent in eight hospitals across the world, including in India, reported the

New England Journal of Medicine

.

The checklist, developed by Dr Atul Gawande, associate professor of surgery at the Harvard Medical School and the World Health Organisation (WHO), identifies 19 surgical safety standards to avoid complications and death. Delhi’s St Stephen’s Hospital participated in the WHO-sponsored study, along with hospitals in Manila, Amman, Seattle, Toronto, London, Auckland and Ifakara in Tanzania.

Gawande, who was born in Brooklyn, is of Indian origin.

The study tracked 7,688 patients between October 2007 and September 2008 and saw death rates drop from 1.5 per cent, before the checklist was introduced, to 0.8 per cent. Serious complications fell from 11 per cent to 7 per cent.

With 234 million major operations done worldwide each year — one for every 25 people alive — the reduction translates into tens of thousands of complications avoided and many lives saved.

“The use of this two-minute checklist ensures that identical procedures are followed in all hospitals across the world,” said Dr Sudhir Joseph, director, St Stephen’s Hospital.

“In St Stephen’s Hospital, there was no discernable difference in death before and after the checklist was introduced, but we found a reduction in complications such as wound infection, which was tracked to antibiotics being administered a little before the recommended one hour before surgery.”

In developing countries, 5 to 10 per cent people die because of complications during major surgery, with improper application of general anesthesia alone causing death in one in 150 surgeries in parts of sub-Saharan Africa. In developed countries, surgical complications range between 3 and 16 per cent, says the WHO, which released the checklist in June last year.

“Our experience shows that using the checklist is a quick and effective way to reduce surgical errors and improve patient safety,” said Dr Joseph.

Cardiac surgeon Dr Naresh Trehan, chairman, Global Health Private Ltd, said: “Standardising protocols are beneficial to any procedure. There is no such thing as a simple surgery, there are only simple-minded surgeons. It is only when you stop paying attention — thinking, ‘Oh, I do this every day’ — that you make mistakes. Checklists like this one help dictate best practices and ensure patient safety.”

The checklist identifies three phases in a surgery, each corresponding to a specific period in the normal flow of work: before the induction of anaesthesia (‘sign in’), before the incision of the skin (‘time out’) and before the patient leaves the operating room (‘sign out’).

In each phase, a checklist coordinator needs to confirm that the medical team has completed the listed tasks before it proceeds with the surgery.

For example, during the ‘sign in’ phase, the coordinator should check whether the surgical site on the patient’s body was properly marked and whether the patient’s known allergies were checked.

During the ‘sign out’ phase, instruments, sponges and needles should be counted to check that none of these is accidentally left behind in the patient’s body.