Effect of the World Health Organization Checklist on Patient Outcomes. Issue 5 (May 2015)

• Record Type: Journal Article
• Authors: Haugen, Arvid Steinar; Søfteland, Eirik; Almeland, Stian K.; Sevdalis, Nick; Vonen, Barthold; Eide, Geir E.; Nortvedt, Monica W.; Harthug, Stig
• Is Part Of: Annals of surgery. Volume 261:Issue 5(2015:May)
• Publication Date: 2015-05
• Subjects: Surgery -- Periodicals; 617.005
• DOI: 10.1097/SLA.0000000000000716
• Languages: English
• ISSNs: 0003-4932

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <sec> <title>Objectives:</title> <p>We hypothesized reduction of 30 days' in-hospital morbidity, mortality, and length of stay postimplementation of the World Health Organization's Surgical Safety Checklist (SSC).</p> </sec> <sec> <title>Background:</title> <p>Reductions of morbidity and mortality have been reported after SSC implementation in pre-/postdesigned studies without controls. Here, we report a randomized controlled trial of the SSC.</p> </sec> <sec> <title>Methods:</title> <p>A stepped wedge cluster randomized controlled trial was conducted in 2 hospitals. We examined effects on in-hospital complications registered by <italic>International Classification of Diseases, Tenth Revision</italic> codes, length of stay, and mortality. The SSC intervention was sequentially rolled out in a random order until all 5 clusters—cardiothoracic, neurosurgery, orthopedic, general, and urologic surgery had received the Checklist. Data were prospectively recorded in control and intervention stages during a 10-month period in 2009–2010.</p> </sec> <sec> <title>Results:</title> <p>A total of 2212 control procedures were compared with 2263 SCC procedures. The complication rates decreased from 19.9% to 11.5% (<italic>P</italic> < 0.001), with absolute risk reduction 8.4 (95% confidence interval, 6.3–10.5) from the control to the SSC stages. Adjusted for possible confounding factors, the SSC effect on complications remained significant with odds ratio 1.95 (95% confidence interval, 1.59–2.40). Mean length of stay decreased by 0.8 days with SCC utilization (95% confidence interval, 0.11–1.43). In-hospital mortality decreased significantly from 1.9% to 0.2% in 1 of the 2 hospitals post-SSC implementation, but the overall reduction (1.6%–1.0%) across hospitals was not significant.</p> </sec> <sec> <title>Conclusions:</title> <p>Implementation of the WHO SSC was associated with robust reduction in morbidity and length of in-hospital stay and some reduction in mortality.</p> </sec> </abstract>