Reading from a piece of paper in the operating room, Sabina Zak, a physician's assistant at Coney Island Hospital waits for the surgical team to respond to each of her questions. "Is this patient X?" Check. "Have we marked the correct body part?" Check. "Does the patient have any known allergies?" Check.

Ms. Zak holds in her hand a powerful tool that will either allow the surgery to proceed or completely halt the procedure: a surgical safety checklist.

More than 225 surgeons in HHC’s 11 hospitals are voluntarily adopting the use of a comprehensive surgical checklist based on recommendations by the World Health Organization (WHO) to help reduce the risk of complications and death associated with the more than 234 million surgical procedures performed each year worldwide.

"The effectiveness of checklists is counterintuitive to many surgical teams who think this simple tool cannot possibly make much of a difference in the very complex environment of the operating room. Yet we have learned from our successful adoption of checklists to reduce hospital-acquired infections in our intensive care units that it is indeed the simple steps that are easily overlooked," said HHC President Alan D. Aviles.

The checklist is designed to foster better communication among surgeons, nurses and anesthesiologists and help the team adhere to the best clinical practices in the over 47,000 surgeries performed in the public hospitals each year.

"HHC's announcement that it will be putting the WHO Safe Surgery checklist into every one of its operating rooms is a major leap forward for patient safety and quality, not just for New York but for the country," said Dr. Atul Gawande, associate professor at the Harvard School of Public Health, and leader of the WHO program that developed the checklist. "This puts it among the first American hospital systems to adopt an approach that we are finding reduces surgical errors dramatically."

Prior to major surgical procedures all across HHC, circulating nurses, or physician assistants like Ms. Zak, will get a verbal confirmation and document more than a dozen safety standard checks beyond the nearly universal check for the right patient, the right site and the right procedure. The HHC checklist will also include re-checking blood type and allergies to drugs; ensuring administration of an appropriate antibiotic (and for cardiac patients, a beta blocker) prior to making an incision; confirming appropriate measures to prevent deep vein thrombosis after surgery; and meticulous accounting to ensure that no instrument, gauze or other foreign body can be left behind.

Studies have shown that checklists work. Eight medical centers from around the world participated in WHO's checklist pilot program. At the start of the program, the hospitals found they were doing everything they should only one third of the time. A thousand operations later, the rate improved dramatically, with some hospitals approaching 100 percent.

HHC's surgical safety checklist is part of the hospital system's multi-year campaign to become one of the safest hospital systems in the country by the year 2010.

September 2008