No surgical procedure is simple or routine

A man is admitted to the emergency room on Halloween, after being stabbed at a party while celebrating a bit too enthusiastically. In the ER, everything seemed routine, the wound superficial – until the man’s blood pressure crashed. The trauma team managed to revive him and later learned that the stab wound had “gone more than a foot through the man’s skin, through the fat, through the muscle, past the intestines, along the left of his spinal column and right into the aorta, the main artery from the heart.” A routine stab wound? How had the knife plunged so deeply? It turns out that the medical team, despite doing almost everything right during the exam, forgot one crucial question. They forgot to ask the man what he’d been stabbed with. They assumed it was a knife. It wasn’t. This was Halloween, after all, and the injured man had been stabbed by a man dressed up like a soldier wielding a bayonet.

Treating and taking care of patients is a lot more complicated than some may realize.
This story, which is from Atul Gawande, MD’s The Checklist Manifesto, illustrates the hardest part of medicine is the extreme complexity of treating and taking care of patients.

There are 13,600 different diagnoses currently recognized by the Integrated Communications and Data system. Clinicians can prescribe more than 6,000 drugs  and carry out nearly 4,000 surgical and medical procedures to treat those diseases, Gawande told members of the South Carolina health care community at the 4th Annual South Carolina Patient Safety Symposium.

“There is nothing simple about any of the conditions that we try to treat or any of the treatments that we try to provide,” he said.

Gawande searched for answers to what clinicians can do differently in order to provide the best care for their patients. The answer was found in the airline industry, which introduced a checklist in 1935.

Using the checklist is a simple way to prompt a team on steps that might fall through the cracks. The checklist identifies pause points, moments in care when you can stop safely and see if you have had a failure and you could correct things.

 “A checklist is a set of values; it reflects humility and the willingness to recognize you don’t know everything, and you might forget things,” he said. “You need discipline to follow a process, and you need to build this around teamwork.”

Gawande, an endocrine and general surgeon, directed  the World Health Organization’s Safe Surgery Saves Lives program, focusing on reducing deaths, complications and disparities in surgery around the world.

The checklist pilot that was initially conducted in eight hospitals around the world revealed that using the checklist reduced complications by an average of 36 percent and death by an average of 50 percent.

Now 100 percent of the SCHA member hospitals, who perform surgical services, have committed to implementing the checklist in every operating room for every surgical patient.

In South Carolina, according to Gawande’s research, 800,000 surgical procedures are performed each year. Of these, about 5,000 surgical deaths occur each year. If we could achieve a 10 percent reduction in complications and mortality compared to the reductions experienced by the World Health Organization, about 500 patients would live to see their families and we would see a $28 million reduction in health care costs.

“The goal is not to do a checklist,” Gawande said. “The goal is to reduce infections and save patients lives.”


05-18-2011 10:28 (EDT)