Checklists dramatically reduce errors in operating room crises

February, 2013

A simulated study of life-threatening surgical crises has found that using a checklist reduced the omission of critical steps from 23% to 6%.

I reported recently on how easily and quickly we can get derailed from a chain of thought (or action). In similar vein, here’s another study that shows how easy it is to omit important steps in an emergency, even when you’re an expert — which is why I’m a great fan of checklists.

Checklists have been shown to dramatically decrease the chances of an error, in areas such as flying and medicine. However, while surgeons may use checklists as a matter of routine (a study a few years ago found that the use of routine checklists before surgery substantially reduced the chances of a serious complication — we can hope that everyone’s now on board with that!), there’s a widespread belief in medicine that operating room crises are too complex for a checklist to be useful. A new study contradicts that belief.

The study involved 17 operating room teams (anesthesia staff, operating room nurses, surgical technologists, a surgeon), who participated in 106 simulated surgical crisis scenarios in a simulated operating room. Each team was randomized to manage half of the scenarios with a set of crisis checklists and the remaining scenarios from memory alone.

When checklists were used, the teams were 74% less likely to miss critical steps. That is, without a checklist, nearly a quarter (23%) of the steps were omitted (an alarming figure!), while with a checklist, only 6% of the steps were omitted on average. Every team performed better when the checklists were available.

After experiencing these situations, almost all (97%) participants said they would want these checklists used if they experienced such a crisis if they were a patient.

It’s comforting to know that airline pilots do have checklists to use in emergency situations. Now we must hope that hospitals come on board with this as well (up-to-date checklists and implementation materials can be found at www.projectcheck.org/crisis).

For the rest of us, the study serves as a reminder that, however practiced we may think we are, forgetting steps in an action plan is only too common, and checklists are an excellent means of dealing with this — in emergency and out.

Reference: 

[3262] Arriaga, A. F., Bader A. M., Wong J. M., Lipsitz S. R., Berry W. R., Ziewacz J. E., et al. (2013).  Simulation-Based Trial of Surgical-Crisis Checklists. New England Journal of Medicine. 368(3), 246 - 253.

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