We discussed the SURPASS (SURgical PAtient Safety System) checklist (de Vries 2010a) in our November 30, 2010 Patient Safety Tip of the Week “ ”. SURPASS is really a series of much shorter checklists, each of which contains items that could be easily overlooked if one were counting on memory alone. Also, it does not contain many items that would seldom be overlooked. Each component checklist requires signing off (and dating) by the appropriate person(s). The authors found that at the Netherlands’ hospitals implementing SURPASS the total number of complications per 100 patients decreased from 27.3 to 16.7 and in-hospital mortality decreased from 1.5% to 0.8%.
The group that developed SURPASS (de Vries 2011) went back and reviewed malpractice claims from a database of the largest insurer in the Netherlands and analyzed the factors contributing to those malpractice cases. They then looked to see how many of those factors might have been covered, and perhaps avoided, if the SURPASS checklist had been used. They found that almost a third (29%) of the contributing factors could have been covered by adherence to SURPASS. And issues related to 4 of the 10 deaths in the database might have been prevented by adherence to SURPASS.
Of course, many of the items may have also been covered by use of other checklists. You’ll recall from our January 20, 2009 Patient Safety Tip of the Week “Haynes 2009).” that mortality at 30-days post-op decreased from 1.5% before introduction of the WHO checklist to 0.8% after and the rate of any complication decreased from 11% to 7% (
The bottom line is that checklists are valuable tools that not only help you improve outcomes and avoid adverse patient events but may also prove useful in reducing malpractice claims and costs.
de Vries EN, Prins HA, Crolla RMPH, et al. for the SURPASS Collaborative Group.Effect of a Comprehensive Surgical Safety System on Patient Outcomes. N Engl J Med 2010; 363: 1928-1937
the SURPASS checklist
de Vries EN; Eikens-Jansen MP, Hamersma AM et al. Prevention of Surgical Malpractice Claims by a Surgical Safety Checklist. Annals of Surgery. (published ahead of print) January 4, 2011
Haynes AB, Weiser TG, Berry WR, et al. for the Safe Surgery Saves Lives Study Group. A Surgical Safety Checklist to Reduce Morbidity and Mortality in a Global Population. N Engl J Med. Online First January 14, 2009 (DOI: 10.1056/NEJMsa0810119), in Print January 29, 2009