How a Checklist Can Postpone Your Bucket List

checklistFiled under the category “humans make bigtime mistakes” is a study that came out earlier this year in the New England Journal of Medicine about the results of using surgery safety checklists at major urban hospitals around the world.  The results, in a word, were lifesaving.   

234 million operations are performed yearly around the globe. It’s difficult to get a handle on the death rate percentage from post-surgery complications, but I’ve seen estimates anywhere from 1.5 to 5% within the first 30 days after surgery.  If we take the low end, that’s more than 3.5 million post-surgery deaths a year. Of that number, a significant percentage–perhaps as high as 50%–is attributable to infections and complications that could have been prevented if safety procedures had been followed.

This study included eight hospitals in eight cities, including Toronto, New Delhi, Manila, London and Seattle — a socioeconomic and cultural cross-section of hospitals that participated in the World Health Organization’s ‘Safe Surgery Saves Lives’ program.  As a benchmark, data was collected on 3,733 consecutively enrolled patients 16 years of age or older who were undergoing noncardiac surgery. 

After the surgical safety checklist was introduced, researchers collected data on 3,955 consecutively enrolled patients with the same criteria. Both the death rate and overall complications rate were analyzed for the first 30 days after the operation.

The results: the rate of death at the hospitals was 1.5% before the checklist was introduced and declined to 0.8% afterward. The rate of complications was 11% before the checklist, declining to 7% after.  In short, using the checklist cut the death and complications rates nearly in half.

Which underlines with a massive boldface line that humans are dangerously mistake-prone, typically well beyond what we’re willing to admit.  Simple tools like checklists are required equipment to counterbalance the foibles of the organs in our skulls.

Other studies of U.S. hospitals further underscore just how important use of safety tools and procedures are to saving lives.  Consider, for example, a study completed in 2007 that compared the top-performing U.S. hospitals with all the rest.  Top hospitals often enjoy larger budgets to attract top talent, so a certain allowance should be made for that — but, another major distinction is that top hospitals are more rigorous in enforcing safety procedures; that is, they do more to prevent human mistakes from manifesting horrible consequences.  The scary result of this study: if you’re admitted to a regular (not-top) hospital in the U.S., you have a 28% higher chance of dying while you’re there than if you had landed at a top-performing hospital. 

To put that another way, if the quality of care at all U.S. hospitals matched that of top-performing hospitals, about 160,000 more lives would have been saved and 12,000 more major complications prevented over a three-year period. If you were one of those 160,000, where the ambulance brought you (and/or where your insurance let you go) made all the difference in the world.

For more on humans and the mistakes we make, check out this interview with Joe Hallinan, who just wrote a book on the subject.

And if you want to scare yourself with more hospital stats, you can search U.S. hospital death rates here.



Filed under About Research

3 responses to “How a Checklist Can Postpone Your Bucket List

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