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A Reminder Of The Value Of Checklists In Medicine

Posted Thursday, October 4, 2018 by Gene Moen

A family member recently attended a “fear of flying” program at SeaTac Airport. She and the other participants met with pilots and other professionals and even visited the air traffic tower and spent some time on the flight deck of an airplane. She was very reassured about the safety procedures that were followed by almost all the members of the “flight team.” She commented about how extensive and exhaustive were the checklists used by the pilots before they took off on a flight and how this avoided the risk of missing some crucial step in getting ready to fly.

It made me think of a recent article I read about the use of checklists when, in a long surgery, a new anesthesiologist takes over anesthesia services. Studies have shown that this kind of “hand-off” can create risks to patient safety. One study showed that there was a combined 14% increase in mortality, hospital re-admission, and major complications occurring within 30 days after an operation in which there was a change of anesthesiologists.

Experts studying this problem felt that the hand-off could be viewed as an opportunity to correct errors if there was the use of a checklist at the time the care is transferred. They concluded that this “might prevent an inadvertent oversight of a required action and resultant patient harm.” Having familiar and standardized communications techniques and tools, such as checklists, can make the hand-off a means of assuring continued good anesthesia care.

A few years ago Dr. Atul Gawande, a surgeon, wrote a book entitled “The Checklist Manifesto.” One reviewer of the book commented that “the routine tasks of surgeons have now become so incredibly complicated that mistakes of one kind or another are virtually inevitable: it’s just too easy for an otherwise competent doctor to miss a step, or forget to ask a key question or, in the stress and pressure of the moment, to fail to plan properly for every eventuality.”

Gawande then visits with pilots and the people who build skyscrapers and comes back with a solution. Professionals, including doctors, need to use more checklists. Note that the pilot checklist that impressed my family member was a partial source of the idea of using such checklists in medicine as well as flight.

In Dr. Gawande’s book, he notes that a secondary advantage of mandating checklists in the surgical setting is that it empowers the non-physician members of the operative team to intervene when a surgeon is rushing into the operation or avoiding some of the steps in the checklist that should be taken. The importance of this was highlighted when the Washington Medical Quality Assurance Commission recently suspended the license of a high-powered neurosurgeon because he had an anger-control problem and would berate other health care providers when they would question what he was doing.

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