In the operating room, a good idea

THE medical community gathers Monday evening at the Museum of Flight to celebrate a public-health achievement in Washington: the adoption of a standardized surgical checklist to prevent mistakes.

The list asks surgical teams questions such as: Is this the right patient? What operation is to be done? Is every member of the team there? Does everyone know who is doing what? Are the instruments ready? The medical images? For diabetics, has the glucose level been checked? For those on beta-blockers for a heart condition, is the medication resumed after the operation?

If it is not, the risk of heart attack increases by four.

"Five years ago, I forgot to restart somebody's beta blocker," said David Flum, a surgeon at the University of Washington Medical Center. "We didn't have a system to remind me."

Now it does, and Flum is a strong supporter.

The UW Medical Center was an early adopter as part of a study across hospitals in eight countries. The study showed that the use of a checklist was followed by a drop in patient infections and deaths in each one of the hospitals.

The results were published in The New England Journal of Medicine more than a year ago. Medical people in this state have taken the lead on it.

"This was a grass-roots initiative," he said. "It is not something the insurance companies made us do, or that the Department of Health forced on us." Medical people did it, with money from the state's Life Sciences Discovery Fund. And it has not been only the surgeons. Crucial backing came from other groups, including the Washington State Nurses Association. It is the nurses who typically control the checklist.

The Web site www.scoap.org/hospitals/index.html names the hospitals that have signed up to use the checklist and those that have not. The "not participating" list is short and should get shorter.