Fall in post-surgical deaths

Deaths following surgery have reduced by more than a third since the implementation of a safety checklist as part of the Scottish Patient Safety Programme.

A study published in the British Journal of Surgery found a 36.6% reduction in mortality since the World Health Organization (WHO) Surgical Safety Checklist was introduced in Scotland’s hospitals in 2008. The 19-item checklist is designed to promote a culture of teamwork and communication in operating theatres, helping to improve surgical care and safety.

The findings are based on an analysis of 6.8 million operations performed between 2000 and 2014, with rates falling to 0.46 deaths per 100 procedures over this period. The fall in death rates was seen only in patients who had surgery.

Scotland’s National Clinical Director Professor Jason Leitch said:

“This is a significant study which highlights the reduction in surgical mortality over the last decade. While there are a number of factors that have contributed to this, it is clear from the research that the introduction of the WHO Surgical Safety Checklist in 2008 has played a key role.

“This decline in mortality has been achieved through the hard work of hundreds of people involved in the project across the NHS in Scotland, delivered under the Scottish Patient Safety Programme alongside a number of other surgical safety measures.

“Behind every one of these statistics is a life saved, demonstrating the impact that the Scottish Patient Safety Programme has had and continues to have on delivering safe, effective and person-centred healthcare for patients. I am delighted that this work, which has the support of Scotland’s Royal Colleges and surgical societies, has been recognised in this way.”

NHS Grampian surgeon and National Clinical Lead for the Scottish Mortality and Morbidity Review Programme Dr Manoj Kumar said:

“This study reaffirms the importance of the WHO Surgical Safety Checklist which functions as a key aide in promoting effective team-working, communication and other relevant non-technical skills in surgery which is critical in ensuring good outcomes.”

Dr Atul Gawande, professor at the Harvard School of Public Health and founder of Ariadne Labs, is a co-author of the study and led the introduction of the WHO Surgical Safety Checklist a decade ago. He said:

“Scotland’s health system is to be congratulated for a multi-year effort that has produced some of the largest population-wide reductions in surgical deaths ever documented.”

Background

Reducing surgical mortality in Scotland by use of the WHO Surgical Safety Checklist

Surgical leaders from Ariadne Labs, a joint centre of Brigham and Women’s Hospital and Harvard T.H. Chan School of Public Health in Boston, served as advisors for the Scotland implementation.

The WHO developed the Surgical Safety Checklist a decade ago with a team of experts led by Dr Gawande. Over the years, the checklist has been widely implemented with different strategies in settings around the world.

The Scottish Patient Safety Programme is part of Healthcare Improvement Scotland’s ihub.