Case Checklists Come in Handy in Crises

Here’s an easy way to cut down on mistakes and improve office performance at crunch time: use standard written checklists for all cases.

Checklists provide accountability and consistency – and they give you something firm to hold onto in a crisis.

Airline pilots complete a checklist before every single flight. They do so even if they’ve committed the list to memory and could take off in their sleep.

Nuclear power crews use checklists for equipment readings throughout the day.

And now a new medical study shows that when doctors and nurses follow a written safety checklist to respond to surgical crises, they are nearly 75 percent less likely to miss a critical clinical step.

Checklists are commonplace in routine medical procedures. But their real value comes when something goes terribly wrong – such as when a patient has cardiac arrest, severe allergic reaction, bleeding or some other crisis during surgery.

“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,” said Atul Gawande, M.D., senior author of the paper, a surgeon at Brigham and Women’s Hospital and professor at the Harvard School of Public Health, in a news release. “Four years ago, we showed that completing a routine checklist before surgery can substantially reduce the likelihood of a major complication. This new work shows that use of a set of carefully crafted checklists during an operating room crisis also has the potential to markedly improve care and safety.”

In the study, 17 different operating room teams – comprised of anesthesia staff, operating room nurses, surgical technologists and a surgeon – were assembled at three Boston area hospitals. Investigators simulated a surgical “emergency” and then sat back and observed how the teams responded:

In half of the crisis scenarios, operating room teams were provided with evidence-based, written checklists. In the other half of crisis scenarios, the teams worked from memory alone. When a checklist was used during a surgical crisis, teams were able to reduce the chances of missing a life-saving step, such as calling for help within 1 minute of a patient experiencing abnormal heart rhythm, by nearly 75 percent, the researchers said.

Examples of simulated surgical emergencies used in the study were air embolism (gas bubbles in the bloodstream), severe allergic reaction, irregular heart rhythms associated with bleeding, or an unexplained drop in blood pressure.

Hospital staff who participated in the study said the checklists were easy to use, helped them feel more prepared, and that they would use the checklists during actual surgical emergencies. In addition, 97 percent of participants said they would want checklists to be used for them if a crisis occurred during their own surgery.

“We know that checklists work to improve safety during routine surgery,” said [Agency for Healthcare Research and Quality] Director Carolyn M. Clancy, M.D. “Now we have compelling evidence that checklists also can help surgical teams perform better during surgical emergencies.”

The results of the study were published in the New England Journal of Medicine and can be viewed here.

What works for doctors should work just as well for lawyers.

In routine, everyday cases, a checklist can help keep things flowing smoothly. And when an alarm bell rings, it just might be your lifeline.

Source: U.S. Department of Health and Human Services, AHRQ

Jay Reeves a/k/a The Risk Man is an attorney licensed in North Carolina and South Carolina. Formerly he was Legal Editor at Lawyers Weekly and Risk Manager at Lawyers Mutual. A checklist helped get this post completed on deadline. jay.reeves@ymail.com, phone 919-619-2441.