A hospital in Windsor, Ont., is changing its surgical checklist in light of at least two cases at another local hospital where women had a breast removed even though they did not have cancer.

Windsor Regional Hospital brought in a checklist to be used in operating rooms in January, but it did not include a verification of any pathology reports.

"Since the recent occurrences at Hôtel-Dieu Grace Hospital we have altered the surgical safety checklist to include that the surgeon, prior to embarking on their operation, if it is a cancer operation, that the pathology report be reviewed one last time," said Shael Liebman, a general surgeon at Windsor Regional Hospital.

Ontario hospitals will include a new policy for verification of biopsy results and pathology reports in April. (CBC)

Dr. Barbara Heartwell, a surgeon at Hôtel-Dieu Grace Hospital, also in Windsor, is under investigation after it was revealed she had performed unnecessary mastectomies on two women, one in 2001 and another in 2009.

In the latter case, Heartwell misread a pathology report, while in the first case it is alleged a report stating the patient didn't have cancer was available, but that Heartwell didn't see it.

Hôtel-Dieu Grace is also leading a review of more than 15,000 patients' tests dating back to August 2003, when Dr. Olive Williams, the local pathologist involved in the cases, was hired to work at the region's laboratory partner, Windsor Essex Pathology Associates.

Williams has been suspended and is under investigation by the Ontario College of Physicians and Surgeons because of alleged errors in her reports.

In late February, the provincial Ministry of Health announced a review of Hôtel-Dieu Grace Hospital, but did not rule out that a review of surgical and pathology practices could expand beyond the Windsor hospital.

Ontario hospitals adopt checklist in April

Liebman said a special clerk in the operating rooms at Windsor Regional Hospital will make sure every surgeon completes the pre-operation checklist.

The mandatory verification list is being implemented Ontario-wide next month.

The new rules, announced in late September, require surgical teams to complete a 26-point checklist and for hospitals to report on their compliance twice a year, starting July 31.

The checklist verifies activities that happen in three parts of surgery: before the anesthesia, before the incision and before the patient leaves the operating room.

It includes things like checking equipment, patient information and reviewing resuscitation plans.

Everyone involved in the procedure must also introduce themselves by name and role before the operation can begin. Sponges, needles and instruments must all be counted to make sure nothing has been left in the patient.

Hospitals already report on eight indicators of patient safety, such as C. difficile rates and hand washing.

Global study finds checklists work

In April 2009, the Information and Privacy Commissioner of Ontario, Ann Cavoukian, recommended provincial hospitals adopt a standardized surgery checklist, in light of a report by the World Health Organization on a global pilot study of such a checklist.

Toronto General Hospital was one of eight hospitals in eight countries to participate in the pilot study. The results of the study, published in the New England Journal of Medicine, found the rate of death following major operations dropped from 1.5 per cent prior to the checklist, to 0.8 per cent after the checklist was implemented.

Patient complications dropped from 11 per cent to seven per cent.