Surgery Checklist - Reducing death, complications and infections


In December of 2013, Democracy for NYC is submitting a Transition Memo to Mayor-elect Bill De Blasio, presenting some specific policy ideas for the new administration. Here is Item #4 from that memo:

Surgery Checklist - Reducing death, complications & infections

The Safe Surgery Checklist is a common sense approach to healthcare that could help save lives and reduce surgical complications for New Yorkers and their loved ones.  Proper use of the checklist, developed by the WHO in 2008, was found to reduce major complications from surgery by 36%, reduce infection rates by nearly 50%, and reduce deaths by 47%. (New England Journal of Medicine, 1/29/09.)  Unfortunately, this checklist is often not used, or used inconsistently, due to medical culture and other factors. (Harvard School of Public Health, 2/7/13.) NYC’s DOHMH could improve healthcare by increasing use of the checklist by surgery teams at local hospitals. In fact, many NYC hospitals could also benefit financially, as there are incentives for healthcare quality improvements under Obamacare.  

Feasibility:  We believe this would not require a change in existing law, but coordination with the state DOH is advisable. Dr. Atul Gawande, who developed the checklist as discussed in his 2010 book The Checklist Manifesto, has set up a non-profit to help hospitals with implementation. 

Additional Information: (Not in the hard copy version of the Transition Memo)

We have been in touch with Safe Surgery 2015, the non-profit set up to implement the safe surgery checklist.  

The good news is that there are great resources, available without cost, to help hospitals increase the use of the checklist for surgical teams, including a video clip from an episode of ER where doctors went over the list, and simple surveys for hospital staff.

The bad news is that this is not simply a matter of calling up a hospital and asking if they are using the checklist. They will likely respond in the affirmative.  The experts at Safe Surgery 2015 have found that use - and proper use - of the checklist increases by changing the culture. People need to talk to people about why this is important. There are many people in hospitals that are advocates of the checklist, and it is possible, that with focus from city government, we can empower checklist supporters to persuade entire surgical teams. 

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