Surgical checklists may not be effective at improving safety, study finds

Checklists are often used in healthcare settings, like operating rooms, to try to prevent adverse patient events like surgical site infections or wrong-site surgery. But checklist-based quality improvement initiatives may not be effective at achieving that goal, according to a study published in JAMA Surgery.

Researchers examined Michigan Hospital Association's Keystone Surgery effort, a checklist-based quality improvement intervention implemented by many hospitals in the state. According to commentary in JAMA Surgery, the Keystone Surgery is based on the successful Keystone ICU program. Keystone Surgery consists of a tool to enhance compliance with process of care measures and a unit-based safety program aimed and improving teamwork and safety culture.

They examined surgical outcomes in 64,891 patients in 29 hospitals from 2006 through 2010 to analyze if implementing the Keystone Surgery program was associated with better outcomes for general surgery patients, looking specifically at surgical site infections, complications and 30-day mortality.

Program implementation was not associated with improved outcomes in the 14 hospitals participating in Keystone Surgery, they found. Rates of surgical site infections, complications and 30-day mortality were similar before and after implementation.

"Additional research is needed to understand why this program was not successful prior to further dissemination and implementation of this model to other populations," the authors concluded.

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