USA - Use checklists, improve communication to reduce surgical complications

Adding to the growing body of evidence on the benefits of surgical checklists, a new study in the December Journal of American College of Surgeons found that a surgical checklist, coupled with communications training, is a cost-effective way to reduce expensive postoperative complications.

For surgical teams who used communications training and the checklist, only 8.2 percent of the procedures resulted in complications within 30 days, according to researchers at the University of Connecticut Health Center in Farmington and Saint Francis Hospital and Medical Center in Hartford.

However, about 16 percent of procedures led to complications within 30 days when surgical teams only had communications training. When surgical teams didn't participate in communications training and didn't use a checklist, more than 23 percent of the procedures resulted in complications.

Training sessions focused on the differences between introverts and extroverts to facilitate effective communication, and everyone on the surgical team had to introduce themselves before the procedure to ensure accountability.

"No one on the surgical team is a nameless, faceless body. The checklist makes sure everyone is advocating for the patient," lead study author Lindsay Bliss, general surgery resident at the University of Connecticut, said yesterday in a statement.

The findings reinforce two studies published last month in Deutsches ÄrzteblattInternational, which found that the most common errors in safety-related behavior in the operating room stem from inadequate communication and ineffective teamwork. Therefore, using a surgical safety checklist, like the one introduced by the World Health Organization in 2007 to improve communication can lower perioperative mortality and morbidity.

Similarly, research from the University of Maryland in May suggested hospitals use checklists before discharging surgical patients to avoid infections.

And while these cost-effective tools will help improve patient safety and care quality, hospitals revenue could still take a hit from fewer surgical complications. In fact, a hospital loses about $1.2 million in annual reimbursement revenue for each 1 percent drop in the complication rate, according to an article in Health Affairs last month.

Alicia Caramenico

For more:
- here's the statement
- check out the study abstract

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