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Thursday, 15 January 2009

Airline-style checklist is to be introduced in NHS operating theatres after a worldwide study shows it cuts deaths and complications after surgery.

Airline-style checklist to be introduced in NHS operating theatres
article in the Telegraph


"The checklist, drawn up by experts at the World Health Organisation, involves stopping all work at three points in an operation, where the staff present confirm they have the right patient, equipment is working, they are about to do the correct surgery, and all needles and swabs are counted before and after to ensure none have been left in the wound.

Eight hospitals around the world recorded surgical complications and deaths before implementing the checklist and afterwards with a total of 7,688 patients involved.

The results, published in the prestigious New England Journal of Medicine, showed that major complications reduced from 11 per cent to seven per cent – a reduction of one third – and deaths dropped from 1.5 per cent to 0.8 per cent – a 40 per cent reduction.

St Mary's Hospital in London, where Health Minister Professor Lord Darzi still works as a surgeon, took part in the study between October 2007 and September 2008.

During the time the hospital was piloting the checklist surgeons removed the gall bladder of the wrong patient, which is exactly the kind of mistake the checklist is designed to stop. The error was made in an operating theatre that was not involved in the study.

A spokesman for Imperial College Healthcare NHS Trust which runs the hospital, said: "The international pilot was undertaken in a limited number of operating theatres, which did not include the one in which the incident took place. Ensuring effective trust-wide implementation of the checklist is a key part of our response to the incident."

Lord Darzi said: "The beauty of the surgical safety checklist is its simplicity and – as a practising surgeon – I would urge surgical teams across the country to use it. "Operating theatres are high-risk environments. By using the checklist for every operation we are improving team communication, saving lives and helping ensure the highest standard of care for our patients. The amazing results from the global pilot puts this beyond any doubt."

The National Patient Safety Agency alerted all NHS trusts to the checklist and will require all relevant organisations to implement a modified version of it by February 2010."

Reducing avoidable deaths and complications would certainly be welcome. - Bearing in mind my own recent experience, I'd recommend also ensuring that bandages are not put on too tightly on patients with thin, delicate skin and weak veins, and are changed for dressings as soon as possible, to avoid unnecessary bruising, swelling, pain and further skin-thinning.

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