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Mortality Trends After a Voluntary Checklist-based Surgical Safety Collaborative.

Publication ,  Journal Article
Haynes, AB; Edmondson, L; Lipsitz, SR; Molina, G; Neville, BA; Singer, SJ; Moonan, AT; Childers, AK; Foster, R; Gibbons, LR; Gawande, AA; Berry, WR
Published in: Annals of surgery
December 2017

To determine whether completion of a voluntary, checklist-based surgical quality improvement program is associated with reduced 30-day postoperative mortality.Despite evidence of efficacy of team-based surgical safety checklists in improving perioperative outcomes in research trials, effective methods of population-based implementation have been lacking. The Safe Surgery 2015 South Carolina program was designed to foster state-wide engagement of hospitals in a voluntary, collaborative implementation of a checklist program.We compared postoperative mortality rates after inpatient surgery in South Carolina utilizing state-wide all-payer discharge claims from 2008 to 2013, linked with state vital statistics, stratifying hospitals on the basis of completion of the checklist program. Changes in risk-adjusted 30-day mortality were compared between hospitals, using propensity score-adjusted difference-in-differences analysis.Fourteen hospitals completed the program by December 2013. Before program launch, there was no difference in mortality trends between the completion cohort and all others (P = 0.33), but postoperative mortality diverged thereafter (P = 0.021). Risk-adjusted 30-day mortality among completers was 3.38% in 2010 and 2.84% in 2013 (P < 0.00001), whereas mortality among other hospitals (n = 44) was 3.50% in 2010 and 3.71% in 2013 (P = 0.3281), reflecting a 22% difference between the groups on difference-in-differences analysis (P = 0.0021).Despite similar pre-existing rates and trends of postoperative mortality, hospitals in South Carolina completing a voluntary checklist-based surgical quality improvement program had a reduction in deaths after inpatient surgery over the first 3 years of the collaborative compared with other hospitals in the state. This may indicate that effective large-scale implementation of a team-based surgical safety checklist is feasible.

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Published In

Annals of surgery

DOI

EISSN

1528-1140

ISSN

0003-4932

Publication Date

December 2017

Volume

266

Issue

6

Start / End Page

923 / 929

Related Subject Headings

  • Surgical Procedures, Operative
  • Surgery
  • South Carolina
  • Risk Adjustment
  • Quality Improvement
  • Propensity Score
  • Program Evaluation
  • Postoperative Complications
  • Patient Safety
  • Middle Aged
 

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Haynes, A. B., Edmondson, L., Lipsitz, S. R., Molina, G., Neville, B. A., Singer, S. J., … Berry, W. R. (2017). Mortality Trends After a Voluntary Checklist-based Surgical Safety Collaborative. Annals of Surgery, 266(6), 923–929. https://doi.org/10.1097/sla.0000000000002249
Haynes, Alex B., Lizabeth Edmondson, Stuart R. Lipsitz, George Molina, Bridget A. Neville, Sara J. Singer, Aunyika T. Moonan, et al. “Mortality Trends After a Voluntary Checklist-based Surgical Safety Collaborative.Annals of Surgery 266, no. 6 (December 2017): 923–29. https://doi.org/10.1097/sla.0000000000002249.
Haynes AB, Edmondson L, Lipsitz SR, Molina G, Neville BA, Singer SJ, et al. Mortality Trends After a Voluntary Checklist-based Surgical Safety Collaborative. Annals of surgery. 2017 Dec;266(6):923–9.
Haynes, Alex B., et al. “Mortality Trends After a Voluntary Checklist-based Surgical Safety Collaborative.Annals of Surgery, vol. 266, no. 6, Dec. 2017, pp. 923–29. Epmc, doi:10.1097/sla.0000000000002249.
Haynes AB, Edmondson L, Lipsitz SR, Molina G, Neville BA, Singer SJ, Moonan AT, Childers AK, Foster R, Gibbons LR, Gawande AA, Berry WR. Mortality Trends After a Voluntary Checklist-based Surgical Safety Collaborative. Annals of surgery. 2017 Dec;266(6):923–929.

Published In

Annals of surgery

DOI

EISSN

1528-1140

ISSN

0003-4932

Publication Date

December 2017

Volume

266

Issue

6

Start / End Page

923 / 929

Related Subject Headings

  • Surgical Procedures, Operative
  • Surgery
  • South Carolina
  • Risk Adjustment
  • Quality Improvement
  • Propensity Score
  • Program Evaluation
  • Postoperative Complications
  • Patient Safety
  • Middle Aged