CAGS and ACS evidence based reviews in surgery. 32: Use of a surgical safety checklist to reduce morbidity and mortality.

Question: Would the implementation of a surgical safety checklist designed to improve team communication and consistency of care reduce major complications and deaths associated with adult noncardiac surgery? Design: Prospective before–after study. Setting: Eight hospitals in 8 cities representing a variety of geographic and economic circumstances and diverse populations. Patients: Patients who underwent noncardiac surgery. Methods: The intervention involved implementation of a 2-step checklist program. Various process and outcome data were collected prospectively before (3733 patients) and after (3955 pa tients) implantation of the checklist. Outcomes: Sur gical site infections, unplanned returns to the operating room, pneumonia, death and any complications. Results: The rate of death was 1.5% before the checklist was introduced and declined to 0.8% afterward (p = 0.003). Complications occurred in 11.0% of inpatients at baseline and in 7.0% after introduction of the checklist (p < 0.001). Conclusion: Implementation of the checklist was associated with concomitant reductions in the rates of death and complications among patients who underwent noncardiac surgery at a diverse group of hospitals.