1. Check a Box. Save a Life. The 1st Global Student Sprint to Improve Healthcare
October 22, 2009

2. Core Aims of Healthcare Improvement
Safe
Effective
Patient Centered
Timely
Efficient
Equitable
The Institute of Medicine created two reports focusing on the quality gap in American Healthcare. In fact they said the problems in the quality of care actually provided versus the care patients expect and should receive is not a gap, but a CHASM! As a result of these reports, the IOM team created a set of 6 aims for improving the delivery of healthcare. These aims are listed in the slide: safety, effective, patient centered, timely, efficient, and equitable
SAFE: a property of the entire system, not just one person
Effective: use the right tools at the right time, don’t misuse or overuse labs tests, imagine, etc.
Patient-centered: be mindful of where the patient is coming from (i.e. attitudes, demographic, culture, religion), the patient is the ultimate decision maker
Timely: avoid useless waiting for the patient, make best use of the time of the patient and physician
Efficient: maximum care at lowest cost (cost is not just financial, it’s time, opportunity, ideas)
Equitable: race, gender, identity and SES should never be barrier to the best available healthcare

3. Safe Surgery Saves Lives
In 2004, the World Health Organization launched a new initiative: the World Alliance for Patient Safety. The World Alliance for Patient Safety has since launched 2 Global Patient Safety Challenges:
The first, “Clean Care is Safer Care”, is an effort to reduce healthcare-associated infection through improved hand hygiene.
The second “Safe Surgery Saves Lives”, was launched in 2007 in an effort to improve global surgical safety, to reduce surgical mortality and complication rates. To achieve this goal, WHO leaders created an evidence-based Checklist.
Safe Surgery Saves Lives 3 3

4. Surgery as Public Health Issue
Regarding Surgery as an under-recognized public health issue:
Estimates show that approximately 234 million major operations are performed every year- one for every 25 human beings on Earth.
This is significantly greater than the incidence of childbirth and HIV cases worldwide.
234 million operations are done globally each year Source: Weiser, Lancet 2008. 4

5. Adverse Outcomes = Known surgical complications of 3-16%
Known death rates of %
At least 7 million disabling complications
1 million deaths worldwide each year =
Yet, few appreciate how high the rates of surgical complications and mortality can be.
At least 7 million people a year experience disabling surgical complications, and more than 1 million die 5

6. WHO Surgical Safety Checklist
This is the second edition of the WHO Safe Surgery Checklist.
Components of the Checklist are designed to address safety issues at 3 distinct points in time for a surgical patient: 1) when the patient ‘signs-in’ to the operating room, prior to induction of anesthesia, 2) during the “Time Out” period immediately prior to incision, and 3) during the post-operative “sign-out” stage, before the patient leaves the operating room.
Each component builds on effective teamwork, keeping all surgical team members attuned to the needs of the patient, and prepared for any expected complications.
The WHO’s “Implementation Manual”, available online, explains each of the components of the Checklist in detail, and offers suggestions about how to run the Checklist in real-time.
The WHO’s website also has simulation video examples of how the Checklist is being run in diverse settings.

7. WHO Surgical Safety
Results of this pilot study were published in the New England Journal of Medicine in January 2009.
(go to next slide for results)
**Nb. The Abstract from the NEJM article is pasted below for additional reference.
The complete NEJM article can be found at:
Background
Surgery has become an integral part of global health care, with an estimated 234
million operations performed yearly. Surgical complications are common and often
preventable. We hypothesized that a program to implement a 19-item surgical
safety checklist designed to improve team communication and consistency of care
would reduce complications and deaths associated with surgery.
Methods
Between October 2007 and September 2008, eight hospitals in eight cities (Toronto,
Canada; New Delhi, India; Amman, Jordan; Auckland, New Zealand; Manila, Philippines;
Ifakara, Tanzania; London, England; and Seattle, WA) representing a variety
of economic circumstances and diverse populations of patients participated in
the World Health Organization’s Safe Surgery Saves Lives program. We prospectively
collected data on clinical processes and outcomes from 3733 consecutively
enrolled patients 16 years of age or older who were undergoing noncardiac surgery.
We subsequently collected data on 3955 consecutively enrolled patients after the
introduction of the Surgical Safety Checklist. The primary end point was the rate of
complications, including death, during hospitalization within the first 30 days after
the operation.
Results
The rate of death was 1.5% before the checklist was introduced and declined to
0.8% afterward (P = 0.003). Inpatient complications occurred in 11.0% of patients at
baseline and in 7.0% after introduction of the checklist (P<0.001).
Conclusions
Implementation of the checklist was associated with concomitant reductions in the
rates of death and complications among patients at least 16 years of age who were
undergoing noncardiac surgery in a diverse group of hospitals. 7

8. Results – All Sites Death rate Before 1.5% After 0.8 % = 47% reduction
Complication rate
Before 11.0%
After %
= 36% reduction
Please Note: This slide has ‘custom animation’. It is made clearer when viewed in Slideshow mode.
Of the 7,688 cases studied, the death rate was 1.5% before the checklist was introduced and 0.8% afterwards (P=0.003). Total inpatient complications occurred in 11.0% of patients at baseline and in 7.0% after introduction of the checklist (P<0.001).
Note to Speaker: click mouse now
The reduced death rate from 1.5% to 0.8% represents a 47% reduction in mortality that was statistically significant in low resource settings and a trend towards decreased mortality in high income settings.
The reduced complication rate from 11.0% to 7.0 % represents a 36% reduction in complications that was statistically significant across all resource settings.
Additional resource specific data is found below:
Rates of complication fell from 10.3% before the introduction of the checklist to 7.1% after its introduction among high-income sites (P<0.001) and from 11.7% to 6.8% among lower-income sites (P<0.001). The rate of death was reduced from 0.9% before checklist introduction to 0.6% afterward at high-income sites (P=0.18) and from 2.1% to 1.0% at lower-income sites (P=0.006), although only the latter difference was significant.
Haynes et al. A Surgical Safety Checklist to Reduce Morbidity and Mortality in a Global Population. New England Journal of Medicine 360: (2009) 8

9. Safe Surgery Student Mentor Project
Vision     
"Students across the world helping to disseminate the WHO Safe Surgery Checklist and partnering to improve healthcare quality"
The Safe Surgery Student Mentor Project’s vision – “students across the world helping to disseminate the WHO Safe Surgery Checklist and partnering to improve healthcare quality – reflects the belief that health professions students can play a meaningful role in improving healthcare quality both domestically and abroad. 9

10. Safe Surgery Student Mentor Project
Mission
Recruit Student Mentors:
-Awareness messengers
-Implementation messengers
-Data collectors
In pursuit of the vision, the project’s mission statement highlights a number of potential opportunities for student involvement.
These opportunities include:
Building awareness about the Checklist
Helping with implementation
Collecting data
Creating a library of case studies / publications based on student dissemination experiences, and
Building an online infrastructure for current and future student-run projects 10

11. Your Checklist: Visit http://www.safesurg.org/student-mentors.html
Have questions?
Download the Toolkit
Raise Awareness
Implement
Collect
Safesurg.org is a website dedicated to the spread and implementation of WHO surgical checklist. It provides lots of information on the checklist itself, how to use it, how to bring it to your institution, and other ways to get involved

12. Discussion Questions What is Quality Improvement?
Do you think it’s important?
Do you want to get involved, in what ways? If not, why not? What challenges do you expect to face? What are deterring factors?
How can students from different disciplines work together?
If you have time before the speakers come on, here are some sample discussion questions

13. Check a Box
Save a LIFE!