title: Thirty-day outcomes support implementation of a surgical safety checklist.
abstract: BACKGROUND
  Thirty-day postoperative complications from unintended harm adversely affect patients and their families and increase institutional health care costs. A surgical checklist is an inexpensive tool that will facilitate effective communication and teamwork. Surgical team training has demonstrated the opportunity for stakeholders to professionally engage one another through leveling of the authority gradient to prevent patient harm. The American College of Surgeons National Surgical Quality Improvement Program database is an outcomes reporting tool capable of validating the use of surgical checklists.
  
  
  METHODS
  Three 60-minute team training sessions were conducted and participants were oriented to the use of a comprehensive surgical checklist. The surgical team used the checklist for high-risk procedures selected from those analyzed for the American College of Surgeons National Surgical Quality Improvement Program. Trained observers assessed the checklist completion and collected data about perioperative communication and safety-compromising events.
  
  
  RESULTS
  Data from the American College of Surgeons National Surgical Quality Improvement Program were compared for 2,079 historical control cases, 246 cases without checklist use, and 73 cases with checklist use. Overall completion of the checklist sections was 97.26%. Comparison of 30-day morbidity demonstrated a statistically significant (p = 0.000) reduction in overall adverse event rates from 23.60% for historical control cases and 15.90% in cases with only team training, to 8.20% in cases with checklist use.
  
  
  CONCLUSIONS
  Use of a comprehensive surgical safety checklist and implementation of a structured team training curriculum produced a statistically significant decrease in 30-day morbidity. Adoption of a comprehensive checklist is feasible with team training intervention and can produce measurable improvements in patient outcomes.
authors.affiliation: University of Connecticut Integrated General Surgery Residency Program, Department of Surgery, University of Connecticut Health Center, 263 Farmington Ave, Farmington, CT 06030, USA.
authors.forename: Lindsay A
authors.initials: LA
authors.lastname: Bliss
authors.forename: Cynthia B
authors.initials: CB
authors.lastname: Ross-Richardson
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Sanzari
authors.forename: David S
authors.initials: DS
authors.lastname: Shapiro
authors.forename: Alexandra E
authors.initials: AE
authors.lastname: Lukianoff
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Bernstein
authors.forename: Scott J
authors.initials: SJ
authors.lastname: Ellner
mesh_terms: D057189:Checklist; D003237:Connecticut / Q000453:epidemiology; D005260:Female; D006284:Health Plan Implementation / Q000458:organization & administration*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009873:Operating Rooms / Q000592:standards; D010348:Patient Care Team / Q000592:standards*; D061214:Patient Safety / Q000592:standards*; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D011446:Prospective Studies; D017751:Safety Management / Q000379:methods*; D013514:Surgical Procedures, Operative / Q000592:standards*