Checklist Can Reduce Costly Complications

Photo: Surgical team

Surgical teams come together for one
common goal — to treat patients using sur-
gical procedures; ©
keybusiness Images

Investigators at the University of Connecticut Health Center, Farmington, and Saint Francis Hospital and Medical Center, Hartford, found that when surgical teams completed communications training and a surgical procedure checklist before, during, and after high-risk operations, patients experienced fewer adverse events such as infections and blood clots.

Surgical teams come together for one common goal — to treat patients using surgical procedures — but occasionally unforeseen circumstances can occur during the process. Sometimes surgical equipment is not on hand, or the patient requires more blood than expected, which delays the procedure and requires dispensing more anesthesia while a team member hurries to get needed supplies. Also, surgical team members may have inconsistent information about priorities for the procedure, explained Doctor Lindsay Bliss, lead study author. As many as five to 20 clinicians can be involved in a single operation, depending on its length and complexity. In a larger hospital, some team members may meet for the first time during the procedure. "Everyone brings to the team a different aspect of patient care that they think is the most important," Bliss said. "But the team has to understand all aspects of patient care and agree on what's important."

Although surgical checklists have existed for a while, they are not universally used. For the study, Bliss's colleagues compared three groups of surgical procedures to determine whether communications training coupled with a standardized checklist could bring surgical teams into agreement and reduce patients' complications.

The communications training included three sessions on topics such as differences between introverts and extroverts, effective dialogue among all operating room personnel, and how to use a surgical checklist. Bliss's team used the one-page Association for Perioperative Registered Nurses Comprehensive Surgical Checklist developed in April 2010.

These procedures were compared with two other groups of surgical procedures that occurred between December 2010 and March 2011. In one group, 246 procedures involved surgical teams who had undergone communications training, while the other group included 73 procedures involving surgical teams who had not only gone through the same communications training but also used the checklist.

Study results showed that the communications training coupled with the checklist curbed complications within 30 days of the procedures. Complications included surgical site infections, vein blood clots, lung blood clots, and urinary tract infections. When surgical teams had no communications training and did not use checklist, more than 23 percent of the procedures resulted in complications within 30 days. About 16 percent of procedures by surgical teams who only participated in communications training led to complications within 30 days, and only 8.2 percent of the procedures had a 30-day complication when the surgical teams used both the communications training and the checklist.; Source: American College of Surgeons