My bachelor’s degree is in engineering. (I hear all of you thinking “Ah! No wonder he’s such a geek.” But I was a geek long before that.) In engineering, safety is an entire field of study with formal ways to account for and measure errors, plan for system failures, and quantify the likelihood of adverse outcomes.
Until the last several years, medicine had a very different culture. Traditionally giving a lot of latitude to physician judgment and autonomy, hospitals had few systems in place to protect patients from unintentional harm.
Yesterday’s astounding emergency landing of an airliner in the Hudson River perfectly crystallizes the engineering safety culture which is practiced daily in aviation. Pilots have checklists and algorithms for everything, from the routine pre-flight list that is checked before every single flight, to what to do in the rare event that both engines lose power. Pilots don’t become excellent by exercising autonomy; they become excellent by doing things by the book.
This week, medicine took a page from the engineering culture and made patients much safer. An important paper in this issue of the New England Journal of Medicine studied the use of a 19-point checklist on all patients undergoing non-cardiac surgery. The study was done in 8 hospitals in 8 cities all over the world including one in Seattle, Washington. The checklist is incredibly simple, and was inexpensive to implement. (I encourage you to look at it by following the link at the bottom of this article.) The list defines 19 steps that should occur before and after every single surgery, like reviewing if the patient has known allergies, checking that the right antibiotic has been given prior to surgery, and having each member of the team introduce herself. Each step is simple to understand and to execute and costs very little.
You would think that most of these common-sense practices would be happening anyway prior to the study, but you’d be wrong. In any case, even with the best of intentions, without an actual list who is going to remember all 19 items at every single surgery?
The results of the study were dramatic. The rate of death due to surgical complications prior to the implementation of the checklist was 1.5% and after the implementation was 0.8%. That means that for every 140 patients for whom the list was used one life was saved. For surgical complications the numbers were even more encouraging. One complication was prevented for every 25 surgeries.
Hospitals are still a very dangerous place, but we’re finally learning from the engineers and getting serious about safety.
(There will not be a medical news post next week. Don’t despair. Posting will resume the following week.)
NY Times article: Simple Checklist Makes Surgery Safer
Wall Street Journal Health Blog post: A Simple Surgical Checklist Saves Lives
New England Journal of Medicine study: A Surgical Safety Checklist to Reduce Morbidity and Mortality in a Global Population