When one considers the great breakthroughs in surgery that gain most public attention, the usual candidates are heart transplants, joint replacements or robotic surgery.  There can be little doubt these headline operations have saved lives or helped relieve many patients’ suffering.

However, as our resources continue to be stretched to near breaking point, it may be time to focus on the relatively inexpensive but highly significant improvements that can be introduced today with far greater effect than any foreseeable new surgery or drugs. Unfortunately, few of these initiatives are likely to capture the public imagination or politicians’ attention, yet if aggressively supported and resourced will have major health gains, save lives and decrease costs.

At last, deep venous thrombosis (DVT) has been fully appreciated as a killer of patients admitted to hospital.   Patients undergoing surgery are particularly at risk, yet this can be largely eliminated or at least reduced by simple measures at the time of surgery and injections of an anticoagulant until recovery has occurred.

Even cheaper is careful attention to hand washing before healthcare staff touch patients.  Recent work continues to suggest that less than 50% of the time hand washing precedes patient interventions.   If we can remember to put on a seat belt, flush a toilet or collect the mail, why can’t doctors and others get into the routine of washing hands before and after patients are examined? In centres with meticulous hand washing and appropriate attention to sterility, infections transmitted by hospitalisation have all but been eliminated. The savings in costs for the Australian healthcare system would be enormous and provide greatly improved outcome for all patients within the health system.

Just as straightforward would be the introduction of a surgical checklist at the time of surgery. Every year in Australia a significant number of patients undergo incorrect procedures because they were not carefully checked off before the intervention.  Further refinement of simple checklists also helps ensure appropriate equipment is always present and special post-operative care is flagged. Surgical checklists cost almost nothing yet have been shown to almost halve mortality and mortality in hospitals in which they are used.

If all Australian hospitals followed DVT protocols, ensured hand washing occurred and demanded serious attention to simple, relevant checklists we could save lives and save money and set a world standard for health care.

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Peter Fray
Peter Fray
Editor-in-chief of Crikey
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