|FOR IMMEDIATE RELEASE
November 24, 2008
Public Hospitals Will Require Surgeons To Use Safety Check List
in Operating Rooms
First Hospital System in NYC to Adopt World Health Organization (WHO) Guidelines
to Improve Communication, Reduce Surgical Errors and Increase Patient Safety
New York City - November 24, 2008 - The New York City Health and Hospitals Corporation (HHC) today announced that all surgical teams in its 11 hospitals will voluntarily adopt the use of a comprehensive check list to prevent errors and make surgery safer. The surgical safety check list was created based on the World Health Organization's (WHO) recommended model to help reduce complications from the more than 234 million surgical procedures performed each year worldwide.
“Hospital checklists are counterintuitive to many surgical teams who think this is a simplistic tool that cannot make a difference in the very complex environment they work in. Yet we have learned from using checklists to reduce hospital acquired infections, that it's indeed the simple steps that are easier to overlook. The checklist ensures all is covered and forces the team to communicate with more precision about what they are doing as well as the outcomes expected for the patient after they leave the OR,” said HHC President Alan D. Aviles.
New York hospitals are already required to conduct “time outs” before surgery to confirm three main standard checks: name of the patient, type of procedure and the correct site of the surgery. The new HHC checklist will exceed those requirements. The extended list of tasks is designed to foster better communication among surgeons, nurses and anesthesiologists and help surgical teams adhere to the best clinical practices in the approximately 8 7,000 surgeries performed in 100 operating rooms each year.
"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, surgeon and associate professor at the Harvard School of Public Health, and leader of the WHO program that developed the checklist. "HHC will be among the first US based hospital systems, and the first one in New York City, to adopt an approach that we are finding reduces surgical errors dramatically.” Before surgery, HHC's 220 surgeons, as well as other members of the surgical teams, will have to verbally confirm and document more than a dozen safety standards that cover three phases: before anesthesia is induced, before skin incision, and before the patient leaves the operating room. A checklist coordinator will confirm that each HHC surgical team has completed the designated task before the next phase of the operation can proceed. The tasks include noting the patients' blood type and allergies to drugs; ensuring beta blockers were given to heart patients prior surgery; screening to prevent deep vein thrombosis after surgery; and accounting for all surgical instruments. After the surgery is completed, the surgeon, anesthesiologist and the nurse must sign the checklist.
“Ten years ago, most surgeons as well as anesthesiologists and nurses would have said there is no need for a checklist. After all, we know our jobs,” said James Barone, MD, Chairman of Surgery at Lincoln Medical and Mental Health Center. “But, today everyone realizes that mistakes do happen, that communication between members of the surgical team is vital and that the checklists do work.”
HHC currently monitors surgical quality by following evidence-based clinical practices that have been proven to reduce the chance of surgical infection, including providing appropriate antibiotics in a timely fashion, or ensure that surgery patients receive the appropriate treatment before and after surgery to prevent blood clots. According to the federal Centers for Medicaid and Medicare Services, CMS, HHC follows those best practices at a rate of 94% - 97% of the time.
“With rigorous adherence to a checklist, we can achieve 100% compliance,” said Aviles.
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 compliance with best practices.
Dr. Gawande added, “Countries abroad, such as the United Kingdom, Ireland, and Jordan, are currently implementing the surgery safety checklist nationwide. The United States will undoubtedly do so, eventually. But we have been slower to embrace the use of checklists in medicine. New York City's public hospitals are proving an unexpected and much welcome exception."
HHC's Surgical Safety Checklist is first being used at Coney Island Hospital, Elmhurst Hospital Center, Kings County Hospital Center, Lincoln Medical and Mental Health Center, Jacobi Medical Center and North Central Bronx Hospital. All other HHC hospitals will be using the checklist by January 2009.
The New York City Health and Hospitals Corporation (HHC), the largest municipal hospital and health care system in the country, is a $5.4 billion public benefit corporation that serves 1.3 million New Yorkers every year and nearly 400,000 who are uninsured. HHC provides medical, mental health and substance abuse services through its 11 acute care hospitals, four skilled nursing facilities, six large diagnostic and treatment centers and more than 80 community based health centers. For more information about HHC, visit www.nyv.gov/hhc.