From PSION (Pediatric Surgery International Online Network)
Recently, at the Pan African Paediatric Surgical Association’s 9th Biennial Conference (18 to 21 March, Capetown, South Africa) a noteworthy lecture was delivered. The lecture was in honour of the Association’s founder Professor Heinz Rode (South Africa). It was titled lecture titled ‘Surgical safety: Checklists and beyond’ , and was brilliantly delivered by Professor Richard Azizkhan (USA).
Prof. Azizkhan reminded delegates that healthcare establishments are environments rich with potential for error and advised that consistent application of established safety precautions can lead to a reduction in adverse events.
He reported that application of the 19 item WHO surgical safety checklist in his hospital ( Cincinnati Children’s Hospital) had led to a reduction in complication rates. For elective cases, complication rates fell from 11% to 7%. This trend was even more pronounced for emergency cases, where the incidence of complications fell from 18.4% to 11.7% . A reduction in death rates was also observed with a drop from 1.5% to 0.8% in elective cases, and 3.4% to 1.4% in emergencies.
He emphasized that the checklist encouraged shared responsibility for safety created a forum for team members to identify and express concerns where appropriate.
Prof Azizkhan also shared with delegates an adverse event in his hospital that was consequent upon communication and leadership gaps which resulted in the death of a patient after surgical intervention, stressing that communication failure was the pivotal factor in 70 – 80% of adverse events.
In other to prevent adverse events, he proposed these guidelines:
1. Competency requirements for staff should be clarified. The required level of competency should be achieved, tested and regularly reviewed.
2. Equipment and supplies should be tried and tested.
3. Leadership model should be established with appropriately defined skills should be set up by service coordinators.
A systematic approach to optimizing these three goals, combined with patient-specific risk assessment should minimise risk from surgical care and provide the team with the right assistance to deliver the safest care. Professor Azizkhan concluded by stating that since applying these recommendations, his institution had not experienced a serious adverse event in more than 500 days!
This lecture was well met by most delegates. One delegate was highly impressed that resource rich centres with low morbidity and mortality rates still pursue greater levels of excellence. Another delegate commented that it was like “news from another planet”. He was determined to convey this to his local institution as a means of encouraging the application of the safety checklist with a view to improving safety of surgical care in an albeit resource poor centre.