Monday, 15 June 2015

Surgical Checklist: a challenged guarantee

The tweet from Dr. Elvira Bisbe ​​warns us that New England has sprung a surprise: a study in Ontario, deployed in 101 hospitals and more than 200,000 cases revealed that the application of a surgical checklist doesn’t significantly reduce complications nor mortality.

Concerned about the finding, I was grateful that Dr. Bisbe’ tweet has led me to The Incidental Economist where Atul Gawande, the father of the surgical checklist, writes the counterpoint. Remember that Dr. Gawande (author of "The Checklist Manifesto") led the team that five years ago convinced us all that with the implementation of a systematic checklist in the operating room while the patient is still awake, complications would be reduced by 35% and mortality by 47%. It must be said in his favour that several subsequent studies, as he himself stresses, have been on the same line: "surgical checklist = more guarantees."

If we take a look at the methodology of the Ontario study, the surprise is as we’ll realize, an assessment undertaken three months after an instruction from the government to deploy the surgical checklist. Dr. Gawande criticizes the lax work methodology but, especially, the weakness in the checklist implementation. As he rightly states, this is a process that requires time and conviction, and it seems that the Ontario study lacks these two requirements.

During this debate over the effectiveness of the surgical checklist, if they have to perform surgery on me, please apply the checklist preferably with some conviction.

Jordi Varela


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