PAHO TODAY          The Newsletter of the Pan American Health Organization   -    July 2008


World Alliance for Patient Safety
Safe Surgery Checklist Launched at PAHO

WHO's new checklist could prevent a half-million surgical deaths each year. Photo Armando Waak/PAHO

A new safety checklist for surgical procedures developed by the World Health Organization (WHO) was launched June 25 at the Pan American Health Organization (PAHO), with the endorsements of nearly 250 health organizations from over 40 countries.

Modeled on pre-flight aviation checklists, the Surgical Safety Checklist is designed to reduce deaths and disabilities from surgery.

"There are 7 million deaths and disabilities due to complications of surgery every year around the world," said WHO Director-General Margaret Chan in a special message for the event. "Half of these could be avoided by following basic standards of care."

The WHO list proposes safety checks during three phases of surgery: before anesthesia is given, before skin incision, and before the patient leaves the operating room. Verification items range from whether the right procedure is being performed on the right patient at the right body site to whether all sponges, needles, and instruments are accounted for after the operation. WHO recommends that a single "checklist coordinator" verify that all members of the surgical team have complied with the checklist.

Atul Gawande, a surgeon and Harvard University professor who led the team that developed the checklist, said at the launch that in his experience, "hardly a day goes by that the checklist doesn't catch a problem."

Preliminary results from 1,000 operations monitored in pilot tests in eight countries show that use of the checklist increased adherence to basic standards of surgical care from 36 percent to 68 percent, and in some hospitals, adherence approached 100 percent.

"Early signs are that progress has already been made, and we have great hopes for this initiative," said Sir Liam Donaldson, chief medical officer of the United Kingdom and chair of the WHO World Alliance for Patient Safety.The alliance's goal is to have the checklist used in 2,500 hospitals by the end of next year and eventually in every operating roomin every country. Britain, Ireland, and Jordan have already pledged to implement the checklist in all of their hospitals.

A study coauthored by Gawande and published in The Lancet the day before the PAHO launch estimates that some 234 million operations are performed worldwide every year, or 1 for every 25 people. Some 6 million patients experience serious complications from these procedures, and about 1million die. Half these incidents could be prevented, the study says.

Chan noted that the Lancet study also highlighted another serious problem: that the vast majority (73.4 percent) of all surgical procedures take place in higher-income countries, while the poorest one-third of the world's countries perform only 3.5 percent of all operations. "We must also address the huge unmet need for surgery in low-income countries," she said.

The endorsements for the WHO checklist came from medical and professional associations, government health agencies, hospitals, and patient advocacy groups from around the world. They include "70 professional associations, ministries of health, and hospitals from 29 countries in the Americas," said PAHO Director Mirta Roses. "Our participation in 'Safe Surgery Saves Lives' is an important step to bring forward the patient safety agenda in the Americas."

Sue Sheridan, leader of the Patients for Patient Safety arm of the World Alliance for Patient Safety, reminded participants in the launch, "Patients have the greatest stake. We challenge you to partner with your patients and inform your patients about the checklist, and make safe surgery a reality."

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