Checklist? … Check

By Ulfat Shaikh

Originally posted on Pulse Sunday, March 3, 2013

Checklists have been criticized as “dumbing down” medicine. However, the evidence that they can save lives is mounting.

A new study earlier this year in the New England Journal of Medicine showed that checklists on hand could help doctors and nurses manage emergencies in the operating room. These include high-complexity and high-stress situations, such as when a person’s heart stops beating or a patient begins bleeding uncontrollably.

“Every team performed better when the crisis checklists were available than when they were not,” the authors write.

Atul Gawande, also the author of the Checklist Manifesto, had 17 operating room teams go through 106 simulated surgical emergencies, with and without checklists. With checklists, the proportion of critical actions missed during emergencies dropped from 23 percent to six percent. Almost all clinicians who participated in these simulations reported they would want a checklist if a crisis occurred during surgery.

Previous research by Gawande’s team demonstrated that using pre-surgical checklists helped reduce the risk of surgical complications. Such checklists are now standard procedure in many operating rooms across the US.

Checklists have been used for years in military and aviation, along with other techniques such as cross-monitoring, feedback, check-back, call-out, SBAR (situation, background, assessment, recommendations) and team training that have been introduced relatively recently into the world of medicine.

The case for techniques to improve team communication (such as check-backs) and standardization of practice (such as checklists) was brought home to me last month as I returned from the TeamSTEPPS Master Trainer course at ISIS, the University of Washington’s Institute for Simulation and Interprofessional Studies. Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) was designed by the Department of Defense and the Agency for Healthcare Research and Quality to integrate teamwork into practice and to improve the quality, safety, and efficiency of health care.

Buckling myself into my seat on the airplane on my way home from Seattle, I felt a sense of heightened awareness as I started to notice flight crew announcements that I had previously just tuned out. As my airplane prepared to push back, I heard the announcement, “Flight attendants, arm doors and cross-check.” With my TEAMStepps training fresh on my mind, I had a feeling of déjà vu when the flight attendant replied, “Doors armed and cross-checked.” I suddenly felt much safer.

Shaikh–Ulfat Shaikh, MD, MPH, MS is director of health care quality at the University of California Davis School of Medicine. She blogs about health care quality improvement at Pulse.

0 thoughts on “Checklist? … Check

  1. As a Marine Platoon Commander in Afghanistan and Iraq, I couldn’t imagine ever not having a checklist with me for calling Medical Evacuations, Air Support, and providing urgent updates over the radio. In high stress situations, checklists are key for making sure the right information is getting passed the right way and at the right time.

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