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de Vries EN, Prins HA, Crolla RM, et al; SURPASS Collaborative Group. N Engl J Med. 2010;363:1928-1937.
A landmark study in patient safety demonstrated remarkable improvement in surgical outcomes through implementation of a checklist for intraoperative and perioperative care. However, inconsistencies in postoperative care are thought to contribute to persistent variation in surgical outcomes between hospitals. In this controlled study, a comprehensive system for the entire surgical pathway—from admission to discharge—was implemented at six teaching hospitals in the Netherlands, and resulted in significant reductions in both complications and overall mortality. The authors note that the success of their intervention relied as much on developing a culture of safety as on the checklist itself, a point supported by another recent study that achieved significant improvement in surgical outcomes through teamwork training.