World Health Organization (WHO) surgical safety checklist implementation and its impact on perioperative morbidity and mortality in an academic medical center in Chile.
Health care organizations are unsafe. Numerous centers have incorporated the WHO Surgical Safety Checklist in their processes with good results; however, only limited information is available about its effectiveness in Latin America. We aimed to evaluate the impact of the checklist implementation on the in-hospital morbidity and mortality rate in a tertiary health care center. After Institutional review board approval, and using data from our hospital administrative records, we conducted a retrospective analysis of all surgical encounters (n = 70,639) over the period from January 2005 to December 2012. Propensity scoring (PS) methods (matching and inverse weighting) were used to compare the pre and postintervention period, after controlling for selection bias. After PS matching (n = 29,250 matched pairs), the in-hospital mortality rate was 0.82% [95% confidence interval (CI), 0.73-0.92] before and 0.65% (95% CI, 0.57-0.74) after checklist implementation [odds ratio (OR) 0.73; 95% CI, 0.61-0.89]. The median length of stay was 3 days [interquartile range (IQR), 1-5] and 2 days (IQR, 1-4) for the pre and postchecklist period, respectively (P < 0.01).This is the first Latin American study reporting a decrease in mortality after the implementation of the WHO Surgical Checklist in adult surgical patients. This is a strong and simple tool to make health care safer, especially in developing countries.
División de Anestesiología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile Clínica Las Condes, Santiago, Chile División de Cirugía, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile Department of Anesthesiology, Perioperative Care & Pain Medicine, New York University School of Medicine, New York, NY.
Hector J
HJ
Lacassie
Constanza
C
Ferdinand
Sergio
S
Guzmán
Lorena
L
Camus
Ghislaine C
GC
Echevarria
D000046:Academic Medical Centers / Q000706:statistics & numerical data*; D057189:Checklist / Q000592:standards*; D002677:Chile / Q000453:epidemiology; D005260:Female; D005544:Forecasting; D019983:Guideline Adherence; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D016017:Odds Ratio; D011183:Postoperative Complications / Q000453:epidemiology* / Q000517:prevention & control; D057216:Propensity Score; D058996:Quality Improvement; D012189:Retrospective Studies; D014944:World Health Organization