Checklists for Crisis and Daily Care

Not surprisingly, a new study has shown that checklists were associated with improvement in the management of operating-room crisis (NEJM 2013;  368: 246-53).

Many people use a checklist just to go to the grocery store so they don’t forget something important.  In medicine, checklists offer the same opportunity.

In this particular study, 17 operating-room teams participated in 106 simulated surgical crisis scenarios.  When checklists were available, there was better adherence to lifesaving processes: only 6% of steps were missed with checklists compared with 23% when they were unavailable.  Every team performed better when the crisis checklists were available.  Furthermore, 97% of participants reported they would prefer to have a checklist in the event of a crisis.

There were many limitations of this study, particularly the absence of surgeons from most of the simulations (due to difficulty enlisting them as volunteers).  Nevertheless, “experts have long recognized the potential for human fallibility in complex systems…it has been nearly 100 years since the surgeon W. Wayne Babcock called for emergency protocols to be rehearsed and ‘posted on the walls of every operating room.'”

For a pediatric gastroenterologist, the implication of this study is much broader.  It is trying to develop a checklist for every patient.  For a patient with a GI bleed, that checklist may include a supply list for the endoscopy suite, having written instructions for the settings of the cautery equipment, checking the proper PPI dose, and drawing a specific set of labs.  Agreeing to a minimum and not-too-onerous checklist would be worthwhile for almost anybody.  If you have a checklist for any GI condition (or a mobile app), think about adding a comment to this posting. If something is important in day-to-day care of a specific condition, a “hardstop” can be incorporated into electronic records as a reminder.

Related blog entries (mostly guidelines –not really checklists for a few specific conditions):

A much more articulate spokesman for checklists would be Atul Gawande:

1 thought on “Checklists for Crisis and Daily Care

  1. Pingback: Practice guidelines and 93 OLTx recommendations | gutsandgrowth

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