South Carolina hospitals see major drop in post-surgical deaths with safety checklist
Boston, MA – South Carolina saw a 22 percent reduction in post-surgical deaths in hospitals that completed a voluntary, statewide program to implement the World Health Organization Surgical Safety Checklist.
The findings of the five-year project between the South Carolina Hospital Association, Ariadne Labs, and Harvard T.H. Chan School of Public Health will appear in the August 2017 print issue of the Annals of Surgery and is published online. The study is the first to demonstrate large-scale population-wide impact of the checklist.
"That is a major reduction in post-surgical mortality and it demonstrates that when done right, the Surgical Safety Checklist can significantly improve patient safety at large scale," said lead author Dr. Alex B. Haynes, associate director of the Ariadne Labs Safe Surgery Program and a surgeon at Massachusetts General Hospital.
Adoption of a safe surgery checklist has been demonstrated to reduce deaths in controlled research studies since 2009. But the ability to produce improved outcomes at large scale has remained questioned.
In the Safe Surgery South Carolina program, all hospitals in the state were invited to participate in a voluntary, statewide effort to complete a twelve-step implementation program with Ariadne Labs that included customizing the checklist for the local setting, doing small scale testing, and observing and coaching on checklist performance. Fourteen hospitals, representing nearly 40 percent of the inpatient surgery volume in the state, completed the program. Researchers compared the 30-day post-surgery mortality outcomes between these hospitals with the mortality outcomes of the rest of the hospitals in the state. Surgical procedures in the analysis represent a wide range of specialties, from neurological, thoracic and cardiac, to soft tissue and orthopedic.
The study found that the post-surgery death rate in the 14 hospitals that completed the program was 3.38 percent in 2010 (prior to implementation) and fell to 2.84 percent in 2013 after implementation. In the other 44 hospitals in the state, mortality was 3.5 percent in 2010 and 3.71 percent in 2013. This corresponded to a 22 percent difference in mortality between the groups.
With these results, South Carolina offers a national model of best practices in implementing a team-based, communication checklist to drive quality improvement in the operating room.
"We are honored to be a learning lab for the rest of the country," said Thornton Kirby, President and CEO of the South Carolina Hospital Association. "The study validates what we hoped and believed from the outset — if you change the operating room culture of how you communicate and coordinate your efforts, you can produce better outcomes."
Ariadne Labs' Executive Director Dr. Atul Gawande led the development of the WHO Surgical Safety Checklist in 2008 with a team of international experts. The 19-item checklist prompts surgical team discussion of the surgical plan, risks, and concerns. Following surgery, patients are at risk of complications and death from a variety of causes such as infection, hemorrhage, and organ failure. Collectively, the checklist items create a culture of operating room communication that improves overall surgical care and safety.
Evidence from a 2009 pilot study with selected operating teams in eight countries around the world demonstrated a 47 percent decrease in post-surgical mortality. Further studies went on to confirm the powerful effect. But translating the checklist into population-wide mortality reduction has not been proven until now.
"Safety checklists can significantly reduce death in surgery. But they won't if surgical teams treat them as just ticking a box," said Gawande. "With this work, South Carolina has demonstrated that surgery checklists can save lives at large scale — and how hospitals can support their teams to do it."
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Ariadne Labs is a global leader in health systems innovation, fostering a new discipline of research and discovery for better patient care from birth to surgery to the end of life. A joint center of Brigham & Women's Hospital and the Harvard T.H. Chan School of Public Health, Ariadne Labs was founded by public health researcher and surgeon Dr. Atul Gawande. The mission is to develop simple, high-impact and scalable solutions that reduce suffering and save lives at the most critical moments in people's lives everywhere.
The South Carolina Hospital Association (SCHA) is a private, not-for-profit organization made up of some 100 member hospitals and health systems. Established in 1921 to serve as the collective voice of the state's hospital community, SCHA is proud to be a part of the state's hospital industry, adding value to hospitals' efforts to care for the people of South Carolina. By helping to keep South Carolina's hospitals healthy, we are helping to keep our state healthy.
Harvard T.H. Chan School of Public Health brings together dedicated experts from many disciplines to educate new generations of global health leaders and produce powerful ideas that improve the lives and health of people everywhere. As a community of leading scientists, educators, and students, we work together to take innovative ideas from the laboratory to people's lives–not only making scientific breakthroughs, but also working to change individual behaviors, public policies, and health care practices. Each year, more than 400 faculty members at Harvard Chan School teach 1,000-plus full-time students from around the world and train thousands more through online and executive education courses. Founded in 1913 as the Harvard-MIT School of Health Officers, the School is recognized as America's oldest professional training program in public health.