Study: SC hospitals see 22% drop in post-surgical deaths with use of checklist-based quality program

South Carolina hospitals that implemented a voluntary checklist-based surgical quality improvement program experienced a 22 percent reduction in post-operative deaths, according to a study in the Annals of Surgery.  

The Safe Surgery South Carolina program invited the state's hospitals to complete a 12-step implementation program of the World Health Organization Surgical Safety Checklist in collaboration with Ariadne Labs, the South Carolina Hospital Association and Boston-based Harvard T.H. Chan School of Public Health. Fourteen hospitals representing about 40 percent of the state's inpatient surgery volume participated in the 12-step program, which included customizing the checklist to each hospital's setting.

Researchers compared post-surgery death rates using statewide all-payer discharge claims from 2008 to 2013. The claims data was linked with state vital statistics and stratified based on hospitals' implementation of the program. In addition, study authors compared changes in risk-adjusted 30-day mortality among hospitals. 

By December 2013, 14 hospitals had completed the checklist-based surgical safety program. Those 14 hospitals saw post-operative deaths decrease from 3.38 percent in 2010 to 2.84 percent in 2013. The hospitals that did not implement the program saw their post-surgery mortality rates increase from 3.5 percent to 3.71 percent in the same time period, representing a 22 percent difference between the groups.

"Our research suggests that the checklist serves as a catalyst for these changes, but that leaders and frontline clinicians, including surgeons, must engage in implementation to produce a meaningful clinical change," the study authors concluded. "Further work in implementation science must focus on identifying factors and interventions that can support or inhibit hospitals' ability to meaningfully employ patient safety innovations." 


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