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    The Royal Australiasian College of Surgeons implemented mandatory “Time Out” for all surgery about 8 years ago. (Indeed it has been so long since it was mandated that I cannot find the original correspondence.) Both public and private hospitals need to demonstrate more than 90% time out compliance to be accredited with the Australian Council on Healthcare Standards. The check in and check out processes that make up part of the WHO Checklist have been mandated processes for all surgery for at least 20 years (as long as I have been a doctor).

    What the NHJM paper demonstrates is that we haven’t all been wasting our time doing the extra paper work.

    The Australian Public should be reassured that between the ACHS and the RACS we have the most up to date, and exhaustive set of surgical standards on the planet.

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    fiona armstrong

    There is certainly strong evidence that the use of clinical protocols (including checklists) can improve the quality and safety of care, and it makes sense that compelling health professionals to make use of evidence through such mechanisms should be occurring. Far too little has been done in Australia by all stakeholders (professional bodies, administrators, bureaucrats, politicians, governments) to address the appalling rate of adverse events that occur, not only in Australian hospitals, but other health care settings too. All should be targets of quality and safety interventions. There is also evidence that incident reporting is higher where protocols exist – another important weapon in the quality and safety toolbox. These and other measures should be employed such as comparative effectiveness research (CER). Sadly the public assume that the interventions they are the recipients of will be based on the best available evidence and that their care is tailored such that the care they receive is actually proven to be the most effective. Of course it is also possible to make cost based decisions using CER, and while there will be concerns about that, it is all part of the transparency and accountability we should be seeing in health care. We will all (as taxpayers, and consumers of health care) be better for it.


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