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April 20, 2017

This checklist helped SC hospitals cut death rates post-surgery by 22 percent

Daily Briefing

Hospitals in South Carolina that adopted a checklist-based surgical safety program had lower post-operative mortality rates when compared with hospitals in the state that did not adopt the program, according to a study published Monday in Annals of Surgery.

Study details

For the study, researchers from the South Carolina Hospital Association, Ariadne Labs, and Harvard University's T.H. Chan School of Public Health reviewed statewide all-payer discharge claims from 2008 to 2013 to compare the 30-day post-operative mortality rates among patients who had inpatient surgeries at South Carolina hospitals. The researchers analyzed data on surgical procedures across a wide range of specialties, according to The State.

Specifically, the researchers compared post-operative mortality rates among 14 South Carolina hospitals that were in the advanced stages of implementing the World Health Organization's (WHO) Surgical Safety Checklist with post-operative mortality rates at 44 other hospitals in that state that had not yet implemented the checklist, The State reports. The 19-item checklist directs medical teams to discuss plans, risks, and concerns related to the surgeries.

According to The State, the study is the first to show the large-scale effect the checklist can have on mortality rates.

JAMA: Why surgical checklists aren't saving lives

Key findings

The researchers found that risk-adjusted 30-day post-operative mortality rates at the 14 hospitals that implemented the checklist fell from 3.38 percent in 2010, before they implemented the checklist, to 2.84 percent in 2013, after they implemented the checklist, representing a decrease of about 22 percent. In comparison, risk-adjusted 30-day post-operative mortality rates at the 44 South Carolina hospitals that had not implemented the checklist increased from 3.5 percent in 2010 to 3.71 percent in 2013, according to the study.

The study authors said the findings "sugges[t] that the checklist serves as a catalyst for" improvements in mortality rates, "but that leaders and frontline clinicians, including surgeons, must engage in implementation to produce a meaningful clinical change." The researchers called for "further work in implementation science  [to] focus on identifying factors and interventions that can support or inhibit hospitals' ability to meaningfully employ patient safety innovations" (Wilkinson, The State, 4/17; Haefner, Becker's Infection Control & Clinical Quality, 4/17; WHO checklist, accessed 4/18). 

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