In 90% of operating rooms in countries like U.S., surgeons use safety checklists

It’s been 10 years since the World Health Organization (WHO) advocated that every hospital in the world use a 19-item checklist to improve patient safety in surgery.

So, how often is it used? A new report (PDF), “Checking in on the Checklist,” found that in countries like the U.S. most surgeons use the safety checklist created to prevent those never events that shouldn't happen in surgery.

However, in poorer countries throughout the world, adoption of the checklist has been slower.

The checklist has been adopted in almost 90% of operating rooms in countries like the U.S. with a high human development index, a measure of health, education and standard of living. In poorer countries, a checklist is used only about a third of the time, according to the report.

Worldwide, the study found that health facilities in 70% of the world’s countries report using the checklist. Its use was found to be associated with a nearly 50% reduction in mortality and a 36% reduction in postoperative complications as well as improved teamwork and communication among members of the surgical team.

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The report details the results of a two-year study carried out by researchers from the WHO and a nonprofit founded by Atul Gawande, M.D., at the Harvard T.H. Chan School of Public Health. The study examined patient outcomes before and after implementation of the checklist at eight hospitals in low-, middle- and high-income countries.

“The uptake of the WHO Surgical Safety Checklist in just 10 years is a significant global health success story,” said Gawande, the surgeon and writer who helped promote the checklist to improve surgical safety. “I am stunned to see how rapidly and enthusiastically the checklist has been adopted.”

Gawande is now CEO of Haven, the healthcare venture led by Amazon, JPMorgan and Berkshire Hathaway.

The report was released Wednesday by nonprofit Lifebox and Ariadne Labs, a joint venture of the Harvard T.H. Chan School of Public Health and Brigham and Women’s Hospital.

Based on lessons learned over the past decade, the report makes recommendations for ways to improve checklist use, especially in hospitals with fewer resources. Those recommendations include getting buy-in from local medical leaders and surgical team members and adapting the checklist to fit local needs.