title: A surgical safety checklist to reduce morbidity and mortality in a global population.
abstract: BACKGROUND
  Surgery has become an integral part of global health care, with an estimated 234 million operations performed yearly. Surgical complications are common and often preventable. We hypothesized that a program to implement a 19-item surgical safety checklist designed to improve team communication and consistency of care would reduce complications and deaths associated with surgery.
  
  
  METHODS
  Between October 2007 and September 2008, eight hospitals in eight cities (Toronto, Canada; New Delhi, India; Amman, Jordan; Auckland, New Zealand; Manila, Philippines; Ifakara, Tanzania; London, England; and Seattle, WA) representing a variety of economic circumstances and diverse populations of patients participated in the World Health Organization's Safe Surgery Saves Lives program. We prospectively collected data on clinical processes and outcomes from 3733 consecutively enrolled patients 16 years of age or older who were undergoing noncardiac surgery. We subsequently collected data on 3955 consecutively enrolled patients after the introduction of the Surgical Safety Checklist. The primary end point was the rate of complications, including death, during hospitalization within the first 30 days after the operation.
  
  
  RESULTS
  The rate of death was 1.5% before the checklist was introduced and declined to 0.8% afterward (P=0.003). Inpatient complications occurred in 11.0% of patients at baseline and in 7.0% after introduction of the checklist (P<0.001).
  
  
  CONCLUSIONS
  Implementation of the checklist was associated with concomitant reductions in the rates of death and complications among patients at least 16 years of age who were undergoing noncardiac surgery in a diverse group of hospitals.
authors.affiliation: Harvard School of Public Health, Massachusetts General Hospital, Boston, USA.
authors.forename: Alex B
authors.initials: AB
authors.lastname: Haynes
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Weiser
authors.forename: William R
authors.initials: WR
authors.lastname: Berry
authors.forename: Stuart R
authors.initials: SR
authors.lastname: Lipsitz
authors.forename: Abdel-Hadi S
authors.initials: AH
authors.lastname: Breizat
authors.forename: E Patchen
authors.initials: EP
authors.lastname: Dellinger
authors.forename: Teodoro
authors.initials: T
authors.lastname: Herbosa
authors.forename: Sudhir
authors.initials: S
authors.lastname: Joseph
authors.forename: Pascience L
authors.initials: PL
authors.lastname: Kibatala
authors.forename: Marie Carmela M
authors.initials: MC
authors.lastname: Lapitan
authors.forename: Alan F
authors.initials: AF
authors.lastname: Merry
authors.forename: Krishna
authors.initials: K
authors.lastname: Moorthy
authors.forename: Richard K
authors.initials: RK
authors.lastname: Reznick
authors.forename: Bryce
authors.initials: B
authors.lastname: Taylor
authors.forename: Atul A
authors.initials: AA
authors.lastname: Gawande
mesh_terms: D006801:Humans; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications / Q000401:mortality / Q000517:prevention & control*; D011446:Prospective Studies; D017751:Safety Management / Q000379:methods* / Q000592:standards; D013514:Surgical Procedures, Operative / Q000401:mortality / Q000592:standards*