The Effect of a Surgical Safety Checklist on Mortality, Morbidity and Cancellation at a South African Tertiary Institute Orthopaedic Department.

Background: Surgical complications are common and most of them are preventable, especially if one considers that 53% to 70% of surgical errors occur outside theatre. Recent studies have shown that pre-operative checklists are associated with improved patient outcome. We hypothesize that in our institution there will be an improvement in patient outcome if a safety checklist is introduced.
Methods: A modified multidisciplinary WHO safety checklist was introduced at our institution on the 1st March 2011. The primary focus was on elective patients admitted in all the units of the division of orthopaedic surgery. We retrospectively collected data from the daily morbidity and mortality (MM) reports presented by the different units of the division of orthopaedic surgery from the 1st January to 31^st May 2011. In addition a preinduction and post-induction survey was completed by all registrars.
Results: The mortality rate decreased by 0.42% (from 1.83% to 1.41%) after the introduction of a surgical safety checklist. There was also a 0.66% reduction in avoidable morbidity (from 1.83% to 1.17%) and a 1.6% reduction in avoidable cancellation (from 2.3% to 0.7%). Only 77% of registrars acknowledged undertaking pre-operative planning prior to implementation of the checklist compared with 87.5% post implementation.
Conclusion: The implementation of the modified WHO safety check list was associated with some reduction in cancellations, avoidable morbidity and mortality. Surgical safety checklists should be regarded as a standard practice for all orthopaedic procedures in order to decrease complications, especially in high operation volume and training centers.