Evidence Classic · Patient safety · Issue 00
Nineteen items, eight cities
A one-page checklist tested in operating theatres from Ifakara to Seattle, and the later study that found something different.
Eight hospitals in all six WHO regions · published 2009
The World Health Organization asked a deliberately simple question: could a short list of checks, spoken aloud at three moments of an operation, make surgery safer in rich and poor hospitals alike?
A team led by Alex Haynes and Atul Gawande tested a 19-item checklist in eight hospitals: in Ifakara, Manila, New Delhi, Amman, Seattle, Toronto, London and Auckland. They followed 7,688 patients before and after it was introduced.
Major complications fell from 11.0% to 7.0%. Deaths fell from 1.5% to 0.8%. The checklist cost almost nothing, and it spread around the world.
Then came the harder chapter. When Ontario required checklists in its hospitals, a large 2014 study found no significant fall in deaths or complications. Most researchers did not conclude that checklists fail. They concluded that a checklist works only as well as the teamwork, training and honest conversation that come with it.
Ticking a box is not the same as having the conversation.
Evidence Passport
- What changed
- A 19-item checklist used at three points: before anaesthesia, before the incision, and before the patient leaves the operating room.
- What was measured
- Major complications and deaths in hospital within 30 days of surgery, before and after, in 7,688 patients.
- Result
- Complications 11.0% → 7.0%. Deaths 1.5% → 0.8%.
- Limits
- A before-and-after study with no control group, and teams knew they were being observed. A later population study in Ontario found no significant change after mandatory adoption.
Sources
- Haynes AB, et al. A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med 2009
- Urbach DR, et al. Introduction of surgical safety checklists in Ontario, Canada. N Engl J Med 2014
An editorial feature about published work. The people named did not apply to Evinca, were not reviewed by us, and are not Evinca honorees.