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Surgical Checklists Unused in 10% of Hospitals, CMS Data Shows

Cheryl Clark, for HealthLeaders Media, July 24, 2014

Given the evidence of how surgical checklists can reduce deaths and complications, it's a mystery why nearly 10% of hospitals still don't mandate their use and why another 12% can't say for certain whether or not checklists are being used.

One week ago, the Centers for Medicare & Medicaid Services' Hospital Compare website started publically reporting which of 4,136 hospitals across the country use surgical checklists and which ones don't.

That, one would think, is a pretty big deal, introducing a level of transparency that would please Brigham & Women's Hospital surgeon Atul Gawande to no end.

After all, it's been seven years since the New Yorker published the first version of his Checklist Manifesto, in which he demonstrated that team time-outs at three intervals during the operation could prevent surgical horror stories.

Gawande's work has shown that a Safe Surgery Safety Checklist can reduce by up to one-third deaths and complications resulting from retained objects, infections, unplanned reoperations, and other procedural horrors such as wrong-site or, heaven forbid, wrong-person surgery.

Now information about which facilities are using checklists is public.

Amazingly, despite so much evidence showing the importance of using checklists in every operating room where surgeries take place, the website shows that, for the calendar year 2012 when the reports were collected, 366 hospitals said they still don't use them and 497 couldn't say whether they did or not.

Imagine that.

Specifically, CMS is now reporting on whether hospitals use a 12-point version of the checklist, one that stops everything at three "critical points" of an operation, before anesthesia, before skin incision, and after surgical site closure but before the patient leaves the operating room.

There are much more complicated adaptations in use, for example Gawande's is a 19-point checklist, so the CMS version seems like a no-brainer.

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3 comments on "Surgical Checklists Unused in 10% of Hospitals, CMS Data Shows"


Joseph (7/29/2014 at 7:22 PM)
The CMS Checklist is strikingly similar to the Checklist of Yisrael Safeek published in American College of Physicians Executives Journal, 2010. http://drsafeeksblog.blogspot.com/2013/03/patient-safety-is-major-public-health.html

sturgeon (7/26/2014 at 8:44 AM)
As a surgeon we have used timeouts and huddles and checklists for years. Yet the errors continue. Cookbook and often ridiculous "motions" wont fix the fundamental issue. Error rates will never be zero but can be minimized by accountability. Anesthesia is often clueless about procedure except thier work and it is usually a "break" person who starts and not the one that worked up the patient. Supplies are often missing despite techs and nurses ensuring they are ready. Xray is usually not present. Its no longer the surgeon always at fault except at institutions with poor peer review and quality of performance standards. The above comment is ludicrous.

Todd (7/24/2014 at 5:38 PM)
Ego, complacency and fear of doctors come to mind about "Bad Data?". Why concern yourself with fundamental error reducing actions when you might risk bothering a doctor who can attract patients to your hospital? Especially when your patients don't know anything about your facility's error rate. But they know doctor names and their friends who have had that surgeon operate on them.