South Carolina saw a 22 percent reduction in post-surgical deaths in hospitals that completed a voluntary, statewide program to implement the World Health Organization Surgical Safety Checklist.

The findings of the five-year project between the South Carolina Hospital Association, Ariadne Labs, and Harvard T.H. Chan School of Public Health appear in the Annals of Surgery. The study is the first to demonstrate large-scale population-wide impact of the checklist.

In the Safe Surgery South Carolina program, all hospitals in the state were invited to participate in a voluntary, statewide effort to complete a twelve-step implementation program with Ariadne Labs that included customizing the checklist for the local setting, doing small scale testing, and observing and coaching on checklist performance. Fourteen hospitals, representing nearly 40 percent of the inpatient surgery volume in the state, completed the program. Researchers compared the 30-day post-surgery mortality outcomes between these hospitals with the mortality outcomes of the rest of the hospitals in the state. Surgical procedures in the analysis represent a wide range of specialties, from neurological, thoracic and cardiac, to soft tissue and orthopedic. 

The study found that the post-surgery death rate in the 14 hospitals that completed the program was 3.38 percent in 2010 (prior to implementation) and fell to 2.84 percent in 2013 after implementation. In the other 44 hospitals in the state, mortality was 3.5 percent in 2010 and 3.71 percent in 2013. This corresponded to a 22 percent difference in mortality between the groups. 

Ariadne Labs’ Executive Director Atul Gawande led the development of the WHO Surgical Safety Checklist in 2008. 

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