Sometimes the low-tech gadgets can still improve care. In one of the largest studies of the kind, a Veteran’s Administration team has shown that implementing checklists before, during, and after surgery, as well as a training program on how to operate effectively as a team using those checklists, has significantly reduced surgical mortality over 2 years in the VA centers involved in the study. The senior author, Dr. James Bagian, an astronaut who knows a thing or two about checklists, was a former director of safety for the VA.
The paper, published in JAMA, explains:
Results The 74 facilities in the training program experienced an 18% reduction in annual mortality (rate ratio [RR], 0.82; 95% confidence interval [CI], 0.76-0.91; P = .01) compared with a 7% decrease among the 34 facilities that had not yet undergone training (RR, 0.93; 95% CI, 0.80-1.06; P = .59). The risk-adjusted mortality rates at baseline were 17 per 1000 procedures per year for the trained facilities and 15 per 1000 procedures per year for the nontrained facilities. At the end of the study, the rates were 14 per 1000 procedures per year for both groups. Propensity matching of the trained and nontrained groups demonstrated that the decline in the risk-adjusted surgical mortality rate was about 50% greater in the training group (RR,1.49; 95% CI, 1.10-2.07; P = .01) than in the nontraining group. A dose-response relationship for additional quarters of the training program was also demonstrated: for every quarter of the training program, a reduction of 0.5 deaths per 1000 procedures occurred (95% CI, 0.2-1.0; P = .001).
Conclusion Participation in the VHA Medical Team Training program was associated with lower surgical mortality.
Notably, in this study the intervention was not just checklists but an integrated training program with quarterly coaching sessions emphasizing that everyone in the OR, including the patient, was responsible for the checklist.
Full study in JAMA: Association Between Implementation of a Medical Team Training Program and Surgical Mortality
AP article: Big VA study shows surgery checklist saves lives…
Image credit: Damon Duncan