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WHO launches safety checklist for surgeons
2008-06-25
WASHINGTON (AFP) - The World Health Organization unveiled a proposal Tuesday to reduce the risks of complications and possible death linked to major surgery by urging surgeons to use a safety checklist, according to a study in the British journal The Lancet. According to the WHO, half of the complications resulting from major surgery may be preventable. Major surgery occurs at a rate of 234 million medical procedures per year -- one for every 25 people -- and studies indicate that a significant percentage of them result in preventable complications and deaths, the WHO reports. About one million people die each year following major surgery, according to WHO figures. Studies have shown that in industrial nations, major complications are reported in three to 16 percent of surgical procedures, according to the WHO, with permanent disability or mortality rates between 0.4 percent and 0.8 percent. "In developing countries, studies suggest a death rate of five to 10 percent during major surgery," while mortality rates from general anesthesia alone "is reported to be as high as one in 150 in parts of sub-Saharan Africa," the WHO said in a statement. "What we identified," said Atul Gawande, a surgeon and Harvard University professor who helped develop the checklist, "was that the idea of a checklist to make sure the basic steps are taken, could make a big difference not only in the poorest part of the world but even in the rich ones." "We borrowed an idea that pilots have for 75 years," Gawande told AFP. "It's like an airline check, you make it short, simple and the team can do better." "This has never been done before -- it's the first time that a checklist for surgical care has been designed and used to reduce complication," Gawande said. "This will be in the hands of the nurse, it's a verbal check." Gawande said the checklist was designed to target the three biggest cause of mortality in surgery -- preventable infections, preventable complication from bleeding, and safety in anesthesia. To test the checklist, the WHO and the team of doctors working on the project, co-directed by Gawande, looked at some of the best medical centers in eight far-flung cities, half in developed nations and half in developing nations: Seattle, in the United States, London, Toronto in Canada, and Auckland in New Zealand, as well as Manila, Amman, New Delhi and a rural district in Tanzania. The team looked at how the medical teams followed six basic steps in care, including verifying that it is the correct patient, that they do not forget a sponge inside the patient, and that they administer an antibiotic before making an incision, which cuts the risk of infection by half. They found that there was a 64 percent probability that at least one of the procedures was forgotten. And based on their figures, they found no difference between hospitals in rich countries and those in developing countries. However after implementing the checklist system, failure rates for the first 1,000 patients dropped by half to 32 percent. "In a couple of place they cut it to 100 percent," he said. More definitive results will be known later in the year after 3,500 major surgical interventions have been studies, he said. In the meantime three countries -- Britain, Ireland and Jordan -- have already adopted the checklist procedures in the operating rooms of their hospitals. WHO officials hope the checklist will be adopted around the world. World Health Organization (WHO)
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