A comparative effectiveness analysis of the implementation of surgical safety checklists in a tertiary care hospital.

Bock M, Doz P, Fanolla A, et al. JAMA Surg. 2016 Feb 3; [Epub ahead of print].

The surgical safety checklist has generally been evaluated based on outcomes that occur within 30 days of the primary operation. For instance, the initial studies by the World Health Organization showed remarkable improvements in mortality and morbidity within 30 days, while a more recent retrospective study following mandated implementation of the checklist throughout Ontario failed to show any enhanced safety outcomes over this same interval. This current study evaluated the introduction of a surgical safety checklist at a single academic Italian hospital, measuring 90-day all-cause mortality, length of stay, and 30-day readmission rates, in addition to 30-day mortality rates. The study included approximately 10,000 patients undergoing noncardiac surgery, with about half in the preintervention and postintervention groups. Following checklist implementation, 90-day mortality significantly decreased, 30-day all-cause mortality was unchanged, and adjusted length of stay dropped from 10.4 to 9.6 days; no difference was found in readmission rates. A recent PSNet interview with Dr. Lucian Leape explored the conflicting findings of the efficacy of surgical safety checklists.