Checklists Found to Limit Errors in Surgical Crisis Situations

Improving patient safety at hospitals and medical clinics is often a matter of getting the little things rights. Sometimes “big” mistakes are still made (i.e. providing a fatal dose of a drug), but in many cases medical errors that cause serious harm are the result of small errors or cut corners that end up blowing up into major complications for patients. For example, considering that it is flu season, something as simple as washing hands regularly and practicing basic sanitary practices 100% of the time can be the difference between life and death. Hospital acquired infections continue to plague hundreds of thousands of patients each year, causing untold harm, prolonged injury, death, and billions of dollars in extra medical costs.

Similarly, the simple step of using a checklist before, during, and after a surgery may mean the difference of life and death. The use of checklists has been a hot topic in the patient safety community for years, and information continues to pour out indicating the effectiveness of the simple tool. Yet, even though the merit of the tool seems obvious, many professionals continue to spurn the use of checklists or only give half-hearted support.

We need to change attitudes and improve hospital safety performance across the board. Most of the resistance is cultural, with professionals feeling confident in their skills and uncomfortable changing things from past practices. On one hand it is easy to understand the frustration of being asked to do something (like use a checklist) which might seem redundant and unnecessary in some cases. On the other hand, the data is clear that use of checklists saves lives, and in the medical context there is simply nothing that should get in the way of actually improving patient care.

More Data Rolling In
According to a new report from the U.S. Department of Health and Human Services’ Agency for Healthcare Research and Quality (AHRQ), when checklists are used surgical teams are 75% less likely to miss some critical clinical step in the surgical process during a crisis. Those “crises” could be something like an allergic reaction or prolonged bleeding and an irregular heartbeat. Obviously medical teams need to respond to these events in a timely and appropriate fashion. Checklists help ensure that proper procedure is followed 100% of the time, giving the patient the best chance of recovering from the crisis.

The article was reported in the online edition of the New England Journal of Medicine this month. The study itself used simulated surgeries performed by seventeen different surgical teams at three different hospitals. Those teams were given different crisis upon which to respond and were evaluated. Half of the teams were given checklists, while the other half worked from memory.

The results were clear. Those with the checklist were significantly less likely to miss a critical step–75% less likely. When multiplied over the countless surgeries performed across the country each year, that improved response to emergencies is literally the difference between life and death.

One senior author of the study reminded that “For decades, we in surgery have believed that surgical crisis situations are too complex for simple checklists to be helpful. This work shows that assumption is wrong.”

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