Checklist saves lives Safe Surgery 2015 intends to improve patient safety in S.C. operating rooms

Dr. Curtis Worthington (right) goes over the Surgical Safety Checklist with nurses Jennifer Dunlap (center) and Anna Angle before operating on a patient Thursday morning at Roper Hospital.

Before Dr. Curtis Worthington ever touches a scalpel in the operating room, before he even scrubs his hands and nails with soap and hot water, he starts with a checklist.

He double-checks the patient's name on her armband, her date of birth and describes out loud to everyone in the room the history of her symptoms.

"The distribution of her pain is S1 pain," Worthington said in a Roper Hospital operating room Thursday morning before he performed simple back surgery.

He pointed to a computer screen showing a black-and-white cross section of the patient's spine.

"It's logical to conclude that this herniated L5-S1 disc is irritating the S1 nerve root and since she can't get better in any other fashion, the goal of the operation is to remove that disc fragment and get the pressure off the nerve root, and hopefully her pain will get better."

While this medical-ese may not make much sense to lay people and probably seems redundant to doctors and nurses that have performed hundreds of similar procedures, health care experts believe that reviewing these details is an important step to ensure mistakes aren't made on the operating table.

"We all agree that's the right side of the patient, correct?," Worthington asked the nurses, technicians and the anesthesiologist in the room.

"Yes, sir," they replied.

"Anything else anybody wants to say? If something occurs in the course of the procedure that you think may be detrimental to the patient, you will speak up, correct?"

"Yes, sir."


This team-based approach that encourages even the lowest-paid, least-educated person in the operating room to speak up if necessary is part of the core mission of the South Carolina Surgical Safety Checklist, which has now been implemented in 100 percent of operating rooms across the state.

"That's a very different culture than has been in health care for a while," said Dr. Todd Shuman, vice president and chief quality officer for Roper St. Francis Healthcare. "In health care, it's always been a little bit of a 'Captain of the Ship' philosophy."

Dr. Atul Gawande, a Boston surgeon and author of several health policy books, including "The Checklist Manifesto," recently told members of the S.C. Hospital Association in Columbia that approximately 5,000 of the 800,000 surgeries performed in South Carolina each year end in death. He estimates that one-third to one-half of those deaths are preventable.

The Safe Surgery 2015 initiative intends to fix that. South Carolina is the pilot state for the program.

"Its goals are to reduce surgical infections, major complications and death through effective population-wide implementation of the World Health Organization Surgical Safety Checklist Program," a press release explained.

Gawande said early results in South Carolina are encouraging. Nineteen hospitals that participated in the program during its first year reported a 15 percent reduction in surgical deaths, he said. That equals about 200 people who didn't die on the operating table.

"Will it continue to go downward?" Gawande asked the group. "We know something is happening. ... It is painfully slow but important work."

While an overwhelming majority of patients surveyed about the initiative agree that the checklist is a good idea, some surgeons have been slower to embrace it, Gawande said. Worthington isn't one of them.

"I don't know exactly why other people haven't signed on to it," Worthington said. "I suspect it's because they think it's unnecessary, that they take sufficient precautions in the normal course of events, but I can't speak for the doctors that don't like to use it. Hopefully, people are increasingly going forward with it."

Reach Lauren Sausser at 937-5598.