Why you should engage with checklists….

de Vries EN, Prins HA, Crolla RM et al. Effect of a comprehensive surgical safety system on patient outcomes. New England Journal of Medicine 2010; 363: 1928-1937.

RHH Journal Club. December 4th, 2012. Dr Surya Kasa

Full-text article (if available)

Does implementation of comprehensive multidisciplinary check list with pre, intra & post op components improve outcome? 

Study design:

  • Multicentre ,Controlled Trial
  • Netherland


  • Population:

Surgical patients admitted for > 24hrs following surgery in selected hospitals

  • Intervention/control:

Intervention-Implementation of Surgical Patient Safety System (SURPASS) Check list to patients admitted to interventional hospitals

Controls1- Patients in the Control hospital

Controls 2- patients in the interventional hospitals before intervention

  • Outcome:

Reduction of peri & postoperative complications and mortality


  • Did groups start with a similar prognosis?

No. They are not compared with one another. The change in the rate of complications within each group at different times is used to draw conclusions.

  • Numbers involved: 12,836
  • Randomisation– Not randomised –not possible
  • Blinded– To a certain extent only for post op complications

Not blinded for patient data like ASA, Age, type of operation, length of hospital stay

  • Intention to treat principle applied. Not applicable
  • Confounding factors :considered
  • Follow up: not appropriate


The use of the comprehensive SURPASS checklist is associated with reductions in complications and mortality among adults undergoing general surgery in hospitals that have a high baseline standard of care


2 thoughts on “Why you should engage with checklists….

  1. Might have been more powerful to use the groups as their own control using a pre & post intervention design? The issue with this methodology is shifting practise in other areas during the trial….

  2. The thing I like about this study is that they measured compliance. The units that had higher compliance with the checklists, showed the biggest improvements in outcomes. This is in stark contrast to the WHO paper (http://www.nejm.org/doi/full/10.1056/NEJMsa0810119?viewType=Print&viewClass=Print&amp😉 where compliance and outcome were unrelated, suggested the benefits seen were nothing to do with the checklist (I imagine the use of pulse oximetry was quite important!!)


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