Surgical Checklist and Patient Safety: More Than Just Checking a Box

Neil H. Winawer, MD

Implementing surgical safety checklists in Ontario, Canada, failed to prevent perioperative mortality or complications.

In 2009, the World Health Organization (WHO) introduced a 19-point surgical safety checklist that significantly lowered the rate of inpatient complications and mortality for patients who underwent noncardiac surgery (NEJM JW Gen Med Feb 3 2009). Despite the checklist's widespread adoption, the effect of mandatory implementation on surgical safety is unclear.

Using administrative data, researchers compared the effects of a surgical checklist at 101 hospitals in Ontario, Canada. After studying 3-month periods before and after implementation of the checklist (>100,000 procedures performed in each period), researchers found no differences in risk-adjusted mortality during hospitalization or within 30 days after surgery (pre-checklist, 0.71%; post-checklist, 0.65%). No differences were seen in risk-adjusted complications or 30-day readmissions. Additionally, the checklist did not prevent operative mortality in any subgroup, including patients who underwent higher-risk procedures, such as emergency or inpatient procedures.

Citation(s):

Urbach DR et al. Introduction of surgical safety checklists in Ontario, Canada. N Engl J Med 2014 Mar 13; 370:1029.

Leape LL.The checklist conundrum. N Engl J Med 2014 Mar 13; 370:1063.