Return of the Checklist!

Paper to the rescue again!

From the January 14th New York Times:

“Surgical complications are a considerable cause of death and disability around the world,” the researchers wrote in the online edition of The New England Journal of Medicine. “They are devastating to patients, costly to health care systems and often preventable.”

But a year after surgical teams at eight hospitals adopted a 19-item checklist, the average patient death rate fell more than 40 percent and the rate of complications fell by about a third, the researchers reported.

We always recommend the primary source at the HFblog, so you can read that for yourself here.

Right-click to download the (PDF).

This is their brief summary of the results:

Results The rate of death was 1.5% before the checklist was introduced and declined to 0.8% afterward (P=0.003). Inpatient complications occurred in 11.0% of patients at baseline and in 7.0% after introduction of the checklist (P<0.001).

I was personally impressed at the scope of this study. They didn’t just look at one hospital, or even several US hospitals. They found these effects in Toronto, Canada; New Delhi, India; Amman, Jordan; Auckland, New Zealand; Manila, Philippines; Ifakara, Tanzania; London, England; and Seattle, WA.

One caveat was the possible presence of the Hawthorne effect. It’s possible, though their data collection spanned 6 months, which sounds long enough for people to relax back into their normal habits.


Haynes, A.B., et al. (2009). A Surgical Safety Checklist to Reduce Morbidity and Mortality in a Global Population. New England Journal of Medicine, 360(5), 491-499.