Prevention of surgical malpractice claims by use of a surgical safety checklist

Ann Surg. 2011 Mar;253(3):624-8. doi: 10.1097/SLA.0b013e3182068880.


Objective: To assess what proportion of surgical malpractice claims might be prevented by the use of a surgical safety checklist.

Background: Surgical disciplines are overrepresented in the distribution of adverse events. The recently described multidisciplinary SURgical PAtient Safety System (SURPASS) checklist covers the entire surgical pathway from admission to discharge and is being validated in various ways. Malpractice claims constitute an important source of information on adverse events. In this study, surgical malpractice claims were evaluated in detail to assess the proportion and nature of claims that might have been prevented if the SURPASS checklist had been used.

Methods: A retrospective claim record review was performed using the database of the largest Dutch insurance company for medical liability. All accepted or settled closed surgical malpractice claims filed as a consequence of an incident that occurred between January 1, 2004 and December 31, 2005 were included. Data on the type and outcome of the incident and contributing factors were extracted. All contributing factors were compared to the SURPASS checklist to assess which incidents the checklist might have prevented.

Results: We included 294 claims. Failure in diagnosis and peroperative damage were the most common types of incident; cognitive contributing factors were present in two-thirds of claims. Of a total of 412 contributing factors, 29% might have been intercepted by the SURPASS checklist. The checklist might have prevented 40% of deaths and 29% of incidents leading to permanent damage.

Conclusion: Nearly one-third of all contributing factors in accepted surgical malpractice claims of patients that had undergone surgery might have been intercepted by using a comprehensive surgical safety checklist. A considerable amount of damage, both physical and financial, is likely to be prevented by using the SURPASS checklist.

MeSH terms

  • Adolescent
  • Adult
  • Checklist*
  • Child
  • Child, Preschool
  • Critical Pathways / standards
  • Diagnostic Errors / prevention & control
  • Diagnostic Errors / statistics & numerical data
  • Female
  • Humans
  • Infant
  • Insurance, Liability / statistics & numerical data
  • Intraoperative Complications / epidemiology
  • Intraoperative Complications / prevention & control*
  • Male
  • Malpractice* / statistics & numerical data
  • Middle Aged
  • Netherlands
  • Patient Care Team / standards
  • Postoperative Complications / epidemiology
  • Postoperative Complications / prevention & control*
  • Preoperative Care / standards
  • Retrospective Studies
  • Safety Management / organization & administration*
  • Safety Management / standards*
  • Surgical Procedures, Operative / standards*
  • Young Adult