Keeping Surgery Safe


This year marked the culmination of a five-year project that led to South Carolina’s hospitals becoming a national model for safe surgery. By working with renowned physician Dr. Atul Gawande’s team at Ariadne Labs and Harvard University to implement the World Health Organization’s (WHO) Surgical Safety Checklist, South Carolina saw a 22 percent reduction in post-surgical deaths at hospitals that participated in the voluntary program.

Through the Safe Surgery South Carolina program, all hospitals in the state were invited to participate in a voluntary twelve-step implementation program with Ariadne Labs that included customizing the checklist for the local setting, small-scale testing, and observing and coaching on checklist performance. Fourteen hospitals, representing nearly 40 percent of the inpatient surgery volume in the state, completed the program. Surgical procedures in the analysis included a wide range of specialties, from neurological, thoracic and cardiac to soft tissue and orthopedic.

The study is the first to demonstrate the large-scale, population-wide impact of the checklist.

The findings of the project between SCHA, Ariadne Labs, and the Harvard T.H. Chan School of Public Health appeared in the August 2017 issue of the Annals of Surgery and online.

“We are honored to be a learning lab for the rest of the country,” said Thornton Kirby, President and CEO of SCHA. “The study validates what we hoped and believed from the outset—if you change the operating room culture and how you communicate and coordinate your efforts, you can produce better outcomes.”

Dr. Gawande led the development of the WHO Surgical Safety Checklist in 2008 with a team of international experts. The 19-item checklist prompts surgical team discussion of the surgical plan as well as risks and concerns. Following surgery, patients are at risk of complications and death from a variety of causes such as infection, hemorrhage and organ failure. Collectively, the checklist items create a culture of operating room communication that improves overall surgical care and safety.

“Safety checklists can significantly reduce death in surgery. But they won’t if surgical teams treat them as just ticking a box,“ said Gawande. “With this work, South Carolina has demonstrated that surgery checklists can save lives at large scale—and how hospitals can support their teams to do it.”