Time out is not just for children anymore; its a step that could save lives in hospitals.
A surgical checklist used to ensure medical teams follow evidence-based standards helps to reduce variations in care as well as the number of complications a patient might experience, according to E. Patchen Dellinger, a physician who is vice chairman of the department of surgery at the 390-bed University of Washington Medical Center. Seattle-based UWMC was one of eight locations worldwidethe only U.S. facilityparticipating in a pilot checklist implementation project conducted by the World Health Organization.
As a result of the pilot study released last week, UWMC will roll out the use of the checklist in all of its operating rooms, specialties and departments by October.
Part of the WHOs Safe Surgery Saves Lives initiative, the checklist helps surgeons and operating teams confirm pre- and post-surgical processes and follow evidence-based guidelines during procedures. The list includes three phasessign in, time out and sign outduring which each task must be checked off before the operation can proceed or conclude.
The WHO checklist establishes basic surgical safety standards that can be applied in all healthcare settings worldwide, and it fosters communication among medical staff and patients, said Dellinger, who led the pilot effort in his hospital and served as a technical expert as the WHO researched what should be on its checklist.
One of the key elements involves every member of the surgical team introducing themselves and explaining his or her role. That allows for a sense of teamwork, he said. Physicians there initially were skeptical that a time out would lead to better outcomes, but the hospital made it clear medical staff would have to adhere to the checklist, Dellinger said. You cant play games or be casual about patient safety.
Medical teams complied with proven standards of care 68% of the time after implementing the checklist, said Atul Gawande, a surgeon at 746-bed Brigham and Womens Hospital, Boston, and an associate professor of surgery at the Harvard School of Public Health, during the WHO conference that announced the checklist and preliminary results from the pilot study. More research will be conducted to study the validity of the checklist findings, he said. Harvard is leading data-collection efforts for the WHO initiative.
The checklist is the second part of the WHOs surgical initiative, which first wanted to raise awareness about the need for hand hygiene in the operating room, Gawande said during the conference. Surgerys role in public health needs to be studied more deeply as more people undergo procedures, said Gawande, who estimated that one in 25 people worldwide now receive a surgical treatment each year.
Research shows that using checklists reduces human error, said Leah Binder, chief executive officer of the Leapfrog Group. Checklists are common tools to help people, I know from my grocery list not to forget the milk, she said, as an example.
In healthcare, checklists help to ensure providers are complying with National Quality Forum-approved practices, she said.
Infection-control proponents favor the use of the checklist as a patient-safety technique as well. Checklists formalize policies and procedures to ensure proper steps are taken in every case, according to Patrick Brennan, president of the Society for Healthcare Epidemiology of America, who testified last week at the Senate Committee on Health, Education, Labor and Pensions hearing about emerging superbug infections. Checklists have been demonstrated using these evidence-based practices to reduce the incidence of ventilator-assisted pneumonia and catheter-related bloodstream infections.