Thursday, 15 January 2009

Check and survive

As you know, I'm far more nervous about going into hospital than I am of getting on a plane. Hospital procedures can be so erratic and staff so careless that I might easily come out in a wooden box.

My qualms have been more than confirmed by a new study that says a simple cockpit-style checklist could cut the death rate after surgery by 47 per cent and the complication rate by 36 per cent.

What's amazing is that this elementary checklist (Sample questions: Is this the right patient? Is this the right limb?) has never been standard practice and hospitals have relied solely on the surgical teams knowing what they're doing.

Unfortunately even the most experienced and intelligent surgeons and nurses are still liable to human errors that can be fatal and irreversible. Once the patient has collapsed and died, the surgeon's experience is not much comfort to the grieving relatives.

So the sooner British hospitals introduce this checklist the better, and the sooner I can have a bit more confidence about checking in.

Some of the questions on the World Health Organisation checklist:
Is this the right patient?
Is this the right operation?
Is this the right limb?
Is this the right organ?
Have we got all the necessary equipment?
Have we got enough blood?
(And afterwards)
Have we removed all the swabs?
Have we removed all the needles?

Stunningly obvious, you might think - but also so obvious they can easily be overlooked.

The successful emergency landing of the plane on New York's Hudson River is astounding. It's practically impossible to land a plane safely on water. It usually disintegrates on impact. The pilot's skill and presence of mind was extraordinary.


Aidan said...

Great post Nick. After my wife's major traffic accident they put a cast on the wrong leg in the hospital she went to. It was frightening that she ended up having to explain what happened at several check-ups as the medical notes were not adequate. Luckily Holland will have an electronic patient dossier from this year so that won't happen in future.

Grannymar said...

I once went to theatre with instructions printed on my thigh in felt tip pen!

My mother and sister had the same name. My mother was once wheeled into theatre (Orthopaedic) with my sister's X-rays. A nosy porter thought my mother looked older than the age on the X-Ray envelope, thankfully he spoke up.

My dad had swabs left inside after emergency surgery way back in '58 - It almost killed him and he limped through life for the next 24 years.

Nick said...

Aidan - You may have heard that the NHS is supposed to be getting a nationwide computerised patient database, but it's years overdue, bogged down in numerous technical problems, and way way over budget. A typical government and civil service shambles.

Nick said...

Grannymar - Write about something like this, and it's amazing how many horror stories come out of the woodwork! Thank goodness for that porter's alertness, and confidence to speak up. And swabs being left inside someone is appallingly common.

Wisewebwoman said...

And there really is no excuse for such shoddy procedures on human beings, is there, particularly when it is life and death we're talking about.
The car mechanic does a better job with his checklist than any surgeon.

Jenny Muir said...

A cockpit checklist is done carefully because if something is overlooked, the pilots are likely to die along with the passengers. In hospitals, it's only the patient who takes the consequences. Go figure.

Nick said...

www - True, if a car mechanic finds a checklist necessary, surely it's even more vital for a surgeon slicing open a human being?

Jenny - Good point. In fact not only do surgeons survive if the patient doesn't, they can keep their jobs for years even if the death rates from their operations are well above average.

Baino said...

I think we must have something like a checklist here. When I had my surgery in 2008 I must have been asked five times about the procedure prior to going under - my name, my age . . my address, confirmation of what I was having - although what went on in theatre, stayed in theatre I guess.

Nick said...

Baino - Wow, thorough or what? But good to know they were so meticulous about getting it right. And yes, I'd love to be a fly on the wall in the theatre and hear what's really going on.

Anonymous said...

Horror stories come with everything these days, don't worry :)

Nick said...

K8 - The funny thing is, although I'm basically frightened of hospitals, if I were actually admitted I'd probably switch to fatalistic mode and say "Oh well, if I die, I die. So what? I've had a good life...."

Fate's Granddaughter said...

I too was amazed when I heard about this simple checklist that it had not already been basic procedure. I have personally had pretty decent experiences with surgeries by the's the after care I've been frustrated with!

I was glad to read your comment on the pilot who landed the plane on the Hudson last week, especially after hearing a lot of radio phone ins and comments belittling the event and questioning the pilot's status as a hero. Sometimes it seems people can't do right for doing wrong.

Nick said...

FG - As Baino says, they have a checklist like that in Oz, so why have we never had one in the UK? Sheer complacency and misplaced deference to the surgeons.

The emergency landing was astonishing. What's more, he landed the plane between two bridges without hitting either of them.