A landmark Australian study led by 2017 Avant Doctor in Training Research Scholarship recipient, Dr Elzerie de Jager, has revealed use of the World Health Organisation Surgical Safety Checklist (WHO SSC) is associated with a significant decrease in postoperative mortality rates in an Australian setting.
Dr de Jager (pictured), a PhD candidate at James Cook University in QLD, received a ‘Quality in Medicine’ grant last year to support the research while working as an intern at the Townsville Hospital.
Research an Australian-first
Dr de Jager is currently a Research Fellow at the Centre for Surgery and Public Health (CSPH), a joint initiative between Brigham and Women’s Hospital, Harvard Medical School and the Harvard T. H Chan School of Public Health, USA. Her interest in improving quality healthcare burgeoned after completing an internship at the WHO headquarters in Geneva, Switzerland in the Patient Safety and Healthcare Quality Department.
The new study, recently published in the World Journal of Surgery, extends on research Dr de Jager conducted during her honours research project.
“There were no previously published studies in Australia examining the effects of the WHO SCC on postoperative outcomes and limited evidence on the effects of the checklist in the long term,” she said. “Therefore, we wanted to validate the ongoing use of the checklist and see if there may be more to surgical safety improvement than ticking checklist boxes.”
The retrospective study analysed the effect of the checklist on postoperative adverse events over a five-year period based on data from 21,306 surgical procedures performed at a public regional tertiary care centre in QLD.
WHO checklist associated with decrease in postoperative mortality
Implementation of the checklist was associated with a 23% decrease in postoperative mortality rates and a 9.6 % decrease in the length of hospital admissions from 5.2 to 4.7 days. The reduction in mortality rates reached statistical significance after the checklist had been implemented for two to three years.
Commenting on the research, Dr de Jager said the results supported use of the checklist in Australian operating rooms.
“This is the first study to demonstrate a significant reduction in postoperative mortality rates after the implementation of the checklist in an Australian setting,” she said.
“The hospital’s regional location and unique patient demographic may have contributed to the checklist having a larger latitude for an effect, compared with studies in an urban setting in other high income settings,” she said.
Dr de Jager also noted the positive effects of the checklist only became significant in the long term, which she said supported the indirect effect of the checklist.
“The checklist aims to work indirectly to improve teamwork, communication and leadership in the operating room,” she said. “Failures in these non-technical skills contribute to most of the cases in which surgery leads to harm. By improving these skills, the checklist aims to build a safer surgical culture which may take some time to develop.”
As for future research, Dr de Jager believed that if the checklist does indirectly improve surgical safety culture, finding the main active ingredient will be crucial.
“If the essential features of the checklist can be sourced, then it may be possible to streamline the checklist itself,” she said.
Avant scholarship opens doors
Dr de Jager said the Avant scholarship was instrumental in funding the research and paved the way for an incredible career opportunity.
“It allowed me to attend and present my work at two conferences – the 2017 World Congress of Surgery in Basel, Switzerland and the 2018 Royal Australian College of Surgeons Conference in Sydney,” she said.
It was her presentation at the World Congress of Surgery that impressed Dr Adil Haider, a moderator at the session. The Director of the CSPH, Dr Haider approached her after the session and asked if she had ever considered a fellowship in the US.
“I was offered a two-year research fellowship in surgical disparities research at the CSPH. In January, I made the move from Townsville in tropical north Queensland to Boston in snowy Massachusetts,” Dr de Jager laughs.
At the CSPH she joined the Metrics for Equitable Access and care in SURgery (MEASUR) project. This collaborative project led by the American College of Surgeons and National Quality Forum, will identify and develop metrics that capture disparities in access and the quality of surgical care provision.
“The MEASUR project will facilitate the development of targeted interventions aimed at eradicating surgical disparities in the United States to ensure optimal access and equitable healthcare for all surgical patients,” Dr de Jager said.
After completing her fellowship, Dr de Jager plans to return to Australia to continue her career in clinical medicine and part-time research, focusing on surgical care.
“There is a disparity in healthcare access and outcomes in the Australian healthcare sector for patients of Aboriginal or Torres Strait Islander descent. I would like to describe the ethnicity dependent discrepancy in surgical access and outcomes in Australia and then look at ways to ‘close the gap’,” Dr de Jager said.
Find out more about the research projects of the 2017 Avant Doctor in Training Research Scholarship recipients.