Day on Torts
SVMIC, the medical malpractice insurer owned by doctors for doctors, has published information about a seminar it offered to its insureds addressing the issue of surgical checklists.
This is how SVMIC describes the seminar it called "“Applied Aviation Safety Practices for Surgeons and Anesthesiologists:”
The basic premise of these seminars was that human errors, often supported by poorly designed systems, are the primary cause of preventable patient deaths and injuries. These human errors share similarities with, and will respond to, many of the same error reduction methods used in high reliability industries such as aviation and nuclear power. One of the hallmarks of high reliability industries is the conscientious and consistent use of checklists.
Do checklists work?
Fast forward to January 2009, and research published in the New England Journal of Medicine that found when surgical teams used a simple checklist — as pilots do before takeoff —patient mortality rates dropped over 40% and complications fell by more than a third.
Is using checklists complicated?
The checklist itself is a single page that requires only a few minutes to complete at three critical junctures of operative care: before anesthesia is administered, before
skin incision, and before the patient is removed from the operating room.
What is on the checklist?
objective evaluation and documentation of the status of the patient’s airway before administration of the anesthetic; the use of pulse oximetry at the time of initiation of anesthesia; the administration of prophylactic antibiotics; oral confirmation, immediately before incision, of the identity of the patient, the operative site, and the procedure to be performed; and completion of a sponge count at the end of the procedure if an incision was made.
How does SVMIC describe the "bottom line?"
Effectively used checklists are a low cost, low effort, low tech tool for improving communication among team members, encouraging consistent and appropriate patient care, and reducing complications and death associated with surgery and other medical mishaps. Even the best tools and systems will fail, however, without commitment from the top levels of an organization to create a “culture of safety.” Physician buy-in is a must. We strongly encourage you to consider the judicious use of checklists in medical and surgical situations where they would be helpful.
The 19 item WHO checklist (shown on page 5) and other supporting materials are freely available on the WHO Safe Surgery Saves Lives site at http://www.who.int/patientsafety/safesurgery/en/. These materials include a Checklist Implementation Manual, Starter Kit with PowerPoint presentation and video examples of how to use the checklist in both a simple and complex case. This is a nice starting point but bear in mind, no checklist is “one size
fits all.” Additions and modifications to fit local practices and institutional needs are encouraged.
Ok, so there is the typical CYA stuff included. Nevertheless, this information is helpful to doctors and lawyers alike.
Read the article and see the checklist here.
Permit me to add this. I know some people think that SVMIC writes these articles and gives seminars to save money on future claims. Perhaps. But I doubt it.
I have disagreements with SVMIC about some portions of their apparent litigation strategy and their evaluation of some claims. I disagree with their support of tort reform (I understand it – I just disagree with the need for some of the protections they want.) That being said, the folks over there (their office is right down the road from mine) do care about patient safety. Saving money on claims by preventing claims is a collateral benefit that just so happens to be very good for patients.