Professor Guy Maddern, professor of surgery at the University of Adelaide, has sent in the following comment re previous posts on whether Australian hospitals should implement the WHO checklist to improve surgical safety:
“Surgery has over many years increased its range of checklists to help ensure patient safety and efficiency. Surgical instrument counts, pre-admission check lists and discharge plans are but a few examples.
There is, however, always resistance to change, particularly with practitioners who, after years of successful (or perceived successful practice), can see little justification to change what has always worked well!
The WHO checklist is a simple bringing together of important information about the patient prior to beginning a surgical procedure. It adds little more than a minute to the procedure, engages the surgeon, anaesthetist and nursing staff in reviewing all vital elements of the procedure and the patient and costs virtually nothing.
Its reported benefits are considerable in both human and financial terms, with decreased mortality and morbidity in the hospitals that implemented the process.
While the checklist seems only sensible, the results of one study cannot be taken without question and further confirmatory studies and refinements will be required to establish how it is best introduced and implemented into Australian healthcare.
The NHMRC will need to evaluate research grants submitted in its 2009 round and must fund such vital research into not only surgical checklists but also surgical clinical practice guidelines. The impact of such simple refinements to practice appear to offer a chance to dramatically cut surgical complications and deaths with a far greater impact than any new antibiotic surgical procedure or high tech robot.
Government, surgeons and hospitals must support its introduction without hesitation while accepting it will undergo inevitable refinement. Even it turns out to provide no added value, it is unlikely to do any harm.
The Royal Australasian College of Surgeons has been a strong supporter of correct site and surgery protocols and will embrace the WHO checklist.
For critics or the recalcitrant, the onus is on them to provide cogent arguments for why such an apparently important improvement should not start immediately, followed by the inevitable subsequent changes.”