UW Medical Center takes part in WHO surgical checklist initiative

UW Medical Center (UWMC) took part in an international broadcast and global launch of the World Health Organization’s “Safe Surgery Saves Lives” campaign Wednesday, June 25. UWMC is the only U.S. site of eight sites around the globe participating in the pilot phase of the project, which involves the use of a checklist for care before, during and after surgery.

Dr. E. Patchen “Patch” Dellinger, vice-chair of surgery, is directing UW efforts and implemented use of the checklist for all general surgical operations at UWMC starting in April. It will be used for all operations by all surgical specialties by fall 2008.

Dellinger’s work coincides with Dr. David Flum’s efforts on the state’s Surgical Clinical Outcomes Assessment Program and is supported by groups including the Washington State Hospital Association, Washington State Nurses Association, Washington State Medical Association, Group Health and others. Flum is a UW associate professor of surgery.

What items are covered on the checklist? Before a patient is rolled into the operating room, medical center staff ask the patient to confirm his or her identity and the procedure. Once in the operating room (OR), all team members introduce themselves by name and role (“I’m Patch, and I’m the surgeon,” is how Dr. Dellinger introduced himself before a recent surgery).

As a visual prompt, the checklist is poster-sized and hangs from an IV (intravenous) pole. The patient’s identity is again confirmed as well as the site of the surgery and procedure due to be performed. The health-care team discusses any anticipated critical events and goes over an antibiotic redosing plan for cases that may last more than three hours. The OR checklist takes from one to four minutes to complete.

Dellinger said the UW “jumped at the chance to be a pilot site” for the WHO initiative. “A lot of us feel as if we don’t know why the checklist hadn’t been there” all along, he said. Not all reactions were initially positive, he admitted. “One surgeon said, ‘It sounds like a good idea as long as I don’t have to do anything I’m not already doing,’” Dellinger said, with a chuckle.

Registered nurse Jodi Bloom said she was initially skeptical because she thought the checklist was cumbersome. “But now, when I go to other specialties, I feel as if something is missing,” Bloom said. (She will no longer have that “missing” feeling as the checklist is rolled out more broadly at UWMC.)

Debby Lunde, also a registered nurse, described herself as perhaps the “biggest skeptic” when it came time to employ the checklist. “It was one more thing that we had to do,” she explained. After a few months of using the checklist, however, Lunde said she is now one of the strongest supporters of the initiative. One of the things she appreciates is the opportunity to ask questions and raise concerns. “I love the way it brings us together in open communication and connection as a team, totally focusing on the patient,” Lunde said.