Doctors have reported that a simple checklist of procedures to be under taken and other such basics can halve the rate of surgery related deaths. The World Health Organization team reported the checklist procedure was similar to the one pilots used before every flight and this simple and inexpensive addition could also cut the complication rate post surgery.

"Using a surgery checklist designed for safety cut the complication and death rate by a more than a third," said lead researcher Dr. Atul Gawande, an associate professor of health policy and management at the Harvard School of Public Health and a surgeon at Brigham and Woman's Hospital, Boston. "The safety of surgery has now become a major public health concern."

The report was published in the Jan. 14 online edition of the New England Journal of Medicine. In the study Gawande's team collected data on 7,688 patients across hospitals in Seattle; Toronto; London; Auckland, New Zealand; Amman, Jordan; New Delhi, India; Manila, Philippines; and Ifakara, Tanzania.

The team collected data on 3,733 patients before using the checklist and on 3,955 patients after surgeons started using the checklist.

The study ran for a year and the team reported that during this period the rate of major complications in operating rooms dropped by more than a third when the checklist was used from 11 % to 7%. The death rate also dropped by more than 40 % when the checklist was introduced. "The death rate was 1.5 percent before the checklist was introduced and declined to 0.8 percent afterward," Dr. Gawande reported.

The one-page checklist developed by Gawande's team is designed to make sure that all those in the operating room communicate important patient information during what is known as "timeouts": before anesthesia is started; before the first incision is made; and before the patient is rolled out of the operating room. Although each surgery is unique there are certain procedures and safety points that are common in all surgeries. "If we miss them, people are harmed," Gawande said.

Many of the items on the checklist are very obvious questions but Gawande said by rechecking even the obvious and potential errors, careless mistakes can be prevented. The checks range from blood supply to sterile equipment and an out-loud roll call of the surgical team to making sure the team is briefed on the amount of blood loss expected, and how long the operation will take. Just making sure an antibiotic is given before the surgery can reduce the risk of complications by half. Pointing out the efficacy of the checklist Dr. Gawande said, "I have been using the checklist for a year, and I don't get through a week when we don't catch something. Often they are small things, but I've seen it save the life of a patient."

Gawande believes that the checklists could help many different areas of medicine, including prevention of hospital-acquired infection, cancer treatment and everyday checkups and is being adopted by hospital associations in five states including Washington, North Carolina, South Carolina, Indiana and New York. In addition, the U.K., the Philippines, Ireland and Jordan plan to adopt the checklist nationwide, he said.

Dr. Jeffrey Salomon, an assistant professor, surgery at Yale University School of Medicine said, "The 'timeout' is mandated in surgery in this country since Medicare indicated that it would not reimburse for a variety of errors such as wrong-side surgery." He added that "It initially seemed a little juvenile to surgeons, but has come to be well-accepted by all operating room personnel. There is little question that it helps reduce avoidable errors, just like an airplane pilot has a checklist to reduce the same."

Dr. Gawande summed it up to say, "The checklists must be short, extremely simple, and carefully tested in the real world. But in specialties ranging from cardiac care to pediatric care, they could become as essential in daily medicine as the stethoscope."