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

Cheryl Clark, 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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