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Checklists in the operating room

November 26, 2008 6:32:59 AM PST
City hosptials are making changes to protect both the patients and their finances. Surgeons are voluntarily adopting the use of a comprehensive surgical checklist based on recommendations by the World Health Organization to help reduce the risk of complications and death.

Accordiing to the WHO, half of the complications resulting from major surgery may be preventable.

The plan is designed to target the three biggest causes of mortality in surgery -- preventable infections, preventable complications from bleeding and safety in anesthesia.

The checklist fosters better communication among surgeons, nurses and anesthesiologists, empowers all members of the team to call a "time out" and helps them adhere to the best clinical practices in the over 47,000 surgeries performed in the NYC public hospitals each year.

You know the drill in a jetliner where the pilot and co-pilot go through a checklist to make sure the plane is prepared and safe for takeoff?

That idea is being tested in six New York City public hospitals, including Lincoln Hospital.

The checklist gets the whole surgical team talking to one another to prevent errors and protect patients. Another goal is making surgery more efficient.

If we just rely on our memory in a middle of a case, we ask for a piece of equipment and someone says you never asked me for it before," Dr. James Barone said.

The list starts with the surgeons, anesthesiologist and nurses at the bedside.

It continues into the operating room with a dry-erase board with the patients and the team members and the surgery. Surgeons are on board, if a little reluctantly.

"The checklist is an imposition, but it does help to get everyone on the same page," Sydney McCalla said.

In a study of checklists, hospitals around the world were doing things right only a third of the time. A thousand operations later with the checklist, they showed dramatic improvement.

Any team member can stop the operation if he or she sees something amiss.

"We feel empowered that the patient is safe in our hands, and that's what we want. That the patient is safe," nurse Arlinda Racaza said.

Safe because the procedures can help prevent infections, operating on the wrong side of the patient and blood clots, to name a few.

The checklists will become standard in New Cork City public hospitals in January.

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