By Alina Haddad
8 July 2008 [MEDIAGLOBAL]: An estimated 234 million major surgeries are conducted each year, and one out of every 25 of these procedures results in preventable complications or death. Infection and other postoperative complications occur in millions of inpatients because hospitals lack standard operating procedures or attention to surgical safety.
In response to this medical quandary, the World Health Organization (WHO), partnered with the World Alliance for Patient Safety (WAPS) to develop the “Safe Surgery Saves Lives” initiative, a new safety checklist for surgical teams to evaluate operating theatres and improve surgical safety to reduce complications and death during surgery around the world. “Preventable surgical injuries and deaths are now a growing concern. Using the Checklist is the best way to reduce surgical errors and improve patient safety,” stated Margaret Chan, Director-General of WHO.
The “Safe Surgery Saves Lives” initiative intends to fulfill its mission of saving lives in three ways. The first is to provide information about the role and pattern of surgical safety in public health sectors to clinicians, hospital administrators, and public health officials. Secondly, it aims to define a minimum set of uniform measures, or ‘surgical vital statistics’, for national and international surveillance of surgical care. Lastly, it will identify a simple set of surgical safety standards and settings that can be applied to operating rooms around the world.
The Checklist identifies the three phases of an operation: before induction of anesthesia, before skin incision, and before the patient leaves the operating room. A ‘Checklist Coordinator’, assigned by the surgical team, confirms that the team has completed its tasks in accordance to the Checklist before it proceeds with the next step of the operation.
The “Safe Surgery Saves Lives” initiative is a collaborative effort led by the Harvard School of Public Health that involves more than 200 national and international medical societies and ministries of health in an effort to meet the global goal of reducing avoidable deaths. The Checklist was developed under the leadership of Dr. Gawande, a surgeon and professor at Harvard, before it was adapted as the WHO Surgical Safety Checklist. “The quality and safety of surgical care has been dismayingly variable in every part of the world. The Safe Surgery Saves Lives initiative aims to change this by raising the standards that patients anywhere can expect,” said Dr. Gawande.
In industrial countries, permanent disability and death is reported to occur in 4 – 8 percent of inpatients. In contrast, in developing countries, death rates are approximated at 5-10 percent during major surgery. For example, in sub-Saharan Africa, mortality from general anesthesia is as high as one in 150. It is for this reason that the “Safe Surgery Saves Lives” initiative is a conscious effort by the WHO and WAPS to improve medical practices in the developing world.
Speaking with MediaGlobal , Dr. Agnès Leotsakos of WAPS explained the particular importance of the Checklist in developing countries, “Developed countries tend to have well-established and codified guidelines for the process of surgical care. However, the least developed countries tend, to lack clear guidelines and policies for directing the preoperative process. The guidelines and checklist can help countries and facilities evaluate their own processes of care and work to improve the safety of that care. In the developed world, there is variability in adhering to basic safety practices.”
The Checklist was disseminated to eight pilot countries to test its affect. These countries are New Zealand, the Philippines, India, Jordan, Tanzania, the United Kingdom, Canada, and the United States. After testing the checklist in these states and studying its results, the WHO and WAPS plan to distribute the Checklist to hospitals worldwide.
Since the dissemination of the Checklist to the pilot sites, adherence to the established medical standards of care has jumped from 36 to 68 percent and in some hospitals to levels approaching 100 percent. The initiative has almost doubled the likelihood that patients will receive standard surgical care.
Dr. Leotsakos shared the findings of the Checklist in the pilot countries, “Preliminary results from pilot site evaluations showed marked improvement in six basic safety practices — confirmation of patient identity by all team members, objective assessment of the airway of the patient, use of pulse oximetry for monitoring, appropriate intravenous access for cases with high blood loss, appropriate timing if antibiotic administration, and counting of sponges by the end of the case. Surgical outcome is more difficult to evaluate, but many of the processes of care are clearly related to improvements in surgical results, such as lower rates of surgical site infections.”
After completing the full evaluation of the Checklist in the pilot countries, the WHO Guidelines and Checklist will be finalized and disseminated to hospitals around the world by the end of 2008.