farmdoc's blog post number 293

Here’s another blog post from the list-man. The last time I was in an operating theatre as a non-patient was in 1971. What struck me was the clarity of purpose, the complexity of process, the slim margin for error, and if error occurred the gravity of its consequence. In theatre, as elsewhere, things can go wrong. And do. Always have, always will. The reasons why they do are legion. Some are preventable, some not. The aim is no error or mistake; optimum outcome in every case. It’ll never happen. But it must remain the aim. This paper, in the 29 January 2009 issue of the New England Journal of Medicine reports on the use of this 19-item checklist in eight hospitals on several continents, on 3,955 surgical patients with 3,733 surgical patient controls. The death rate and complication rate were both reduced – to a highly statistically significant degree – after the checklist’s introduction. This elegant study produced an important result which is cost-effective in terms of both human and financial cost. But it has broader implication because it shows how complex problems are amenable to simple solutions. In other words, complex problems don’t always require complex solutions. Data suggest that at least 50% of surgical complications are avoidable. Eliminating that 50% is the first objective. Eliminating the unavoidable 50% will take longer!