Piloting the Basics

Maureen Larkin, for HealthLeaders Media, July 24, 2008

When's the last time you saw a surgeon jump up and down?

E. Patchen "Patch" Dellinger, vice-chair of surgery at the University of Washington Medical Center, says he did just that when the World Health Organization offered his hospital the chance to pilot a surgical safety checklist that was announced to the public last month.

"I work at a marvelous academic medical center. But it's a pretty big place, and has a way of making changes slowly," says Dellinger. Using the WHO surgical checklist, he says, was an opportunity for the medical center to weave certain safety precautions into its culture—a bit sooner than it might have otherwise. "When they asked for pilot sites, I thought, this is my chance."

Like the checklist studied late last year by Johns Hopkins researcher Peter Pronovost, MD, the WHO checklist isn't complicated. Each item is a simple task that, when completed, can improve the safety of a patient during surgery, reduce the chance of infection, and increase communication among the surgical team members while in the OR. A quick introduction of everyone in the operating room—including the patient—is just one item that must be checked off before surgery begins.

During the pilot period, Dellinger, who was on one of four working groups that helped create the list, made sure that the checklist was posted next to the operating table during every general surgery. A research coordinator kept track of the tasks and timed how long it took the team to get through the items on the list.

Dellinger's excitement for the WHO checklist spread throughout the hospital after it was shown that during the first 500 pilot surgeries, UW's error rate had been cut in half. It didn't take much to convince hospital leadership to take the program beyond general surgery. By October 1, use of the checklist will be mandated for every surgery performed at UW.

Of course, convincing not only executives, but members of the surgical teams, that the checklist was a good idea wasn't as easy as it sounds. At first, Dellinger did meet some resistance from those who feared the checklist would add to their workload. "Some said it was a good idea provided they didn't have to do anything more than they were already doing," he says. And with tight OR schedules, others feared that the checklist would add unnecessary time in to the procedure.

"I had our research coordinator time the checklist dozens of times," Dellinger says. "The average time it took was one minute, fifty seconds. The longest was three minutes, fifty seconds—and that was a very complicated case."

The bottom line, he says, is that checklists make sense, and they've been proven to work, and not just during the WHO pilot project. He points to the success of the lists at Johns Hopkins and other healthcare organizations that have similar policies in place.

"As they've found in aviation, as medicine gets more complex, the potential for errors increases dramatically," says Dellinger. "We can prevent errors by making sure that we have a systematic process in place to check for errors."

Maureen Larkin is quality editor with HealthLeaders magazine. She can be reached at mlarkin@healthleadersmedia.com.
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