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

Area of Science:

• Healthcare Quality Improvement
• Patient Safety
• Surgical Outcomes

Background:

• Surgical safety checklists improve outcomes in trials, but population-based implementation is challenging.
• The Safe Surgery 2015 South Carolina program aimed for state-wide voluntary adoption of a checklist.
• This study evaluated the impact of this collaborative implementation on mortality.

Purpose of the Study:

• To determine if completing a voluntary, checklist-based surgical quality improvement program is linked to lower 30-day postoperative mortality.
• To assess the feasibility of large-scale implementation of team-based surgical safety checklists.

Main Methods:

• Compared 30-day postoperative mortality rates in South Carolina hospitals from 2008-2013.
• Utilized state-wide all-payer discharge claims linked with vital statistics.
• Employed propensity score-adjusted difference-in-differences analysis to compare hospitals completing the program versus others.

Main Results:

• Hospitals completing the program showed a significant decrease in risk-adjusted 30-day mortality (3.38% to 2.84%, P < 0.00001).
• Mortality rates in non-completing hospitals remained stable (3.50% to 3.71%, P = 0.3281).
• A 22% difference in mortality reduction was observed between groups (P = 0.0021).

Conclusions:

• Voluntary checklist implementation was associated with reduced inpatient surgical deaths in South Carolina.
• The findings suggest that large-scale, collaborative implementation of surgical safety checklists is achievable.
• This program offers a potential model for improving surgical quality and patient safety across a state.