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Journal Article > Study
Validity of unplanned admission to an intensive care unit as a measure of patient safety in surgical patients.
Haller G, Myles PS, Wolfe R, Weeks AM, Stoelwinder J, McNeil J. Anesthesiology. 2005;103:1121-1129.
Based on a recommended clinical indicator in surgical patients, this study used a cohort of more than 44,000 to identify 200 patients who experienced an unplanned postoperative admission to an intensive care unit. Investigators discovered that more than half of these patients experienced at least one incident or near miss and that their mortality rates and lengths of stay were significantly increased, while their likelihood for discharge was decreased. The authors conclude that this methodology may serve as an important tool to promote patient safety by generating data that do not require complex risk-adjustment models and rely on more easily obtainable information from a medical chart.
Journal Article > Review
Effect of using a safety checklist on patient complications after surgery: a systematic review and meta-analysis.
Gillespie BM, Chaboyer W, Thalib L, John M, Fairweather N, Slater K. Anesthesiology. 2014;120:1380-1389.
In contrast to a recent study that showed no change in postoperative morbidity and mortality following checklist adoption, this systematic review explored the evidence and found that checklist implementation was linked to a reduction in overall surgical complications. The authors recommend that checklists be used with other interventions to augment safety.
Journal Article > Review
Postoperative adverse events inconsistently improved by the World Health Organization surgical safety checklist: a systematic literature review of 25 studies.
de Jager E, McKenna C, Bartlett L, Gunnarsson R, Ho YH. World J Surg. 2016;40:1842-1858.
The World Health Organization surgical safety checklist garnered a great deal of attention after initial studies showed remarkable reductions in postoperative complication rates. However, subsequent studies failed to reproduce these results, engendering controversy about the true effectiveness of checklists in real-world settings. This systematic review of 25 studies of the surgical safety checklist found that complication rates decreased with checklist usage in resource-poor settings, but the checklist did not appear to be effective in developed nations. The authors also noted that the reported effect of the checklist was incongruous—in several studies, postoperative complications did not decrease, but postoperative mortality improved, raising questions about what mechanism helped the checklist achieve its effect. These concerns, along with methodological problems in many of the included studies, led the authors to postulate that the observed improvements seen in some studies may have been due to temporal changes or other interventions rather than the checklist itself.