Surgical checklists might cut malpractice claims

NEW YORK (Reuters Health) - Surgical checklists not only save lives by preventing medical errors, they could also make a big dent in medical malpractice claims, Dutch researchers say.

Scouring data from the largest medical liability insurer in the Netherlands, they found nearly a third of the claims arose from mistakes that likely would have been caught by a checklist.

Putting a price tag on the medical liability system is difficult, but one 2010 study estimated it costs the U.S. more than $55 billion annually, or 2.4 percent of the country's healthcare spending.

In addition, experts say tens of thousands of Americans die every year due to medical errors -- most of which are related to surgery, according to the Dutch report.

Earlier studies have shown that when healthcare providers follow a checklist, they reduce those deaths dramatically. And they could save money, too, by preventing complications that require further treatment.

"This kind of evidence indicates that surgeons who do not use one of these checklists are endangering patients," said Dr. Atul Gawande of the Harvard School of Public Health in Boston, a surgeon who has written extensively on the topic.

Yet only about a fourth of U.S. hospitals use one of the three checklists that have been proven to work, Gawande said.

If they turn out to curb malpractice lawsuits too, he added, "I don't know what more we want in order for hospitals to adopt the concept."

In the current study, the researchers identified the main reasons for errors in 294 successful claims related to surgeries from 2004 to 2005. They then compared those to the items on a comprehensive surgical checklist called SURPASS, which is now used in several hospital in the Netherlands.

It includes simple things like making sure the operating schedule is correct, checking that all equipment is available, and marking on which side of the patient the surgery is going to happen.

"While the checklist as a whole may seem a little intimidating, the separate parts for each stage of the surgical pathway take little time to complete," Dr. Eefje de Vries, of the Academic Medical Centre in Amsterdam, and colleagues write in the Annals of Surgery.

They found 29 percent of the reasons something had gone wrong corresponded to an item on the checklist, such as marking the patient or communication between hospital staff.

And in four of the 10 deaths in the claims database, at least one of the contributing factors was addressed in the checklist.

While there is no guarantee the checklist would actually have averted those deaths had it been used at the time, the researchers say it would likely have prevented "a considerable amount of damage, both physical and financial."

"These are striking findings," said Gawande, who directs the World Health Organization's Global Challenge for Safer Surgical Care.

He said the liability insurer for his own hospital, Brigham and Women's in Boston, had come to a similar conclusion about the WHO checklist used there.

"The message for hospitals is you want to adopt one of these checklists," said Gawande.

SOURCE: http://bit.ly/hmFN4M Annals of Surgery, online January 4, 2011.