Evaluation and optimization of a safety checklist covering critical safety risks in surgical patients.
12 / 2005 - unknown
A large proportion of adverse events and medical errors (i.e., preventable adverse events) is encountered during hospital admission and in particular around surgical procedures. A recent estimate of the Dutch situation by the National Institute for Public Health and the Environment (RIVM) based upon the results of the notorious report of the Americam Institute of Medicine (IOM) 'To err is human' indicates that 1500 - 6225 patients per year die as a consequence of preventable adverse events in hospital. A large proportion of adverse events and medical errors (i.e., preventable adverse events) is encountered during hospital admission and in particular around surgical procedures. An adverse event can be defined as an event associated with an adverse outcome involving prolonged care, injury, or death caused by medical management rather than by the underlying disease or condition of the patient (1-5). A recent estimate of the Dutch situation by the National Institute for Public Health and the Environment (RIVM) based upon the results of the notorious report of the Americam Institute of Medicine (IOM) 'To err is human' indicates that 1500 - 6225 patients per year die as a consequence of preventable adverse events in hospital (4). British authorities estimated that 40.000 hospitalized patients die annually as a result of adverse events (13). Within hospitals, medical errors account for a significant patient morbidity, mortality and increased healthcare costs (6-8). Almost 50% of hospital events are related to a surgical operation and at least half of surgery-related events are regarded as 'preventable' (8). The latter category of events is the target of the present proposal. Checklists are only potentially useful and effective when the majority (if not all) of the preventable critical events are covered by the checklist items, and items are displayed and checked in a sequence that is logical for clinical practice. To evaluate and optimize the newly developed 'surgical patient safety system' (SURPASS) checklist for coverage of critical safety events that can lead to adverse events in surgical patients. In a systematic review section, we pooled data from 8 studies and found that adverse events were seen in 13.1 (2.9 - 36.0) % of patients. Of these events, 49.0 (32.6 - 69.0) % were regarded as preventable events or errors. The median adverse event mortality rate was 6.0 (1.7 - 8.0) %. Ranked in order of frequency by location of the incident, the operating room had by far the highest frequency of adverse events (41.0%, range 39.5 - 46.8) (2,4). When events were ranked in order of incidence per discipline, surgical departments were at the top of the list (42.7%, range 39.4 - 46.1). Two studies that examined exclusively surgical patients found a percentage of complications of 12.0 (6.3 - 17.7) %, of which 56.1 (49.0 - 63.2) % was jugded to be preventable. The growing awareness of adverse event data and patient safety hazards is also expressed in various recent national reports (www.snellerbeter.nl; www.npcf.nl, www.rivm.nl, www.rgo.nl). It is obvious that safety enhancing measures are of the utmost importance. Design The surgical patient safety (SURPASS) checklist - based upon published adverse event data, checklist design reports, complication / necrology dialogue meetings and expert consensus - will run in consecutive surgical patients scheduled (no emergency procedures in this study) for one of the top ten selected 'sentinel' procedures. These sentinel surgical procedures are categorized by anatomical location and are preselected by a high frequency of the procedures multiplied by the level of risk (in terms of adverse events) accompanying the procedures.