Surgical Safety Checklists
Surgical Safety Checklists
Checklists can be adopted in varied formats. They may constitute a series of 'read and do' checks, for instance for checking a piece of equipment. They may be 'challenge/response' checks to confirm that procedures have been completed, or an 'aide memoire' to provide a series of structured prompts for a team briefing or debriefing. Or they may be a combination of all three. Checklists were first introduced in aviation in the 1930s to address human error, as newer more complex aircraft were introduced, and are now common in high-risk industries. Much is known about checklist development from industry—for example, checklists should ideally be one page, use simple familiar language, and each element should contain no more than five to nine items.
Checklist design requires consideration of content, format, timing, trial, and feedback, followed by formal testing and evaluation. Checklists should be evidence-based and address key safety items that are often overlooked, and which, if omitted, would lead to serious adverse outcomes. By standardizing performance, checklists reduce reliance on memory and thus reduce errors of omission. This is particularly applicable to healthcare as processes become more complex, staff become busier, and handovers and shift working become more common. Checklists contribute to team communication and working and increase situational awareness among team members, but successful adoption requires careful implementation to make sure that the checklist is used effectively.
There are clearly differences between healthcare and ultra safe industries such as commercial aviation, and some of these differences may be a significant barrier to using the same techniques at risk reduction. For instance, clinicians typically value clinical autonomy and view themselves as individual craftsmen rather than members of a team after standard operating procedures. These differences help to explain why the implementation of checklists and routine adoption of safety briefings in healthcare may not be straightforward.
Checklists
Checklists can be adopted in varied formats. They may constitute a series of 'read and do' checks, for instance for checking a piece of equipment. They may be 'challenge/response' checks to confirm that procedures have been completed, or an 'aide memoire' to provide a series of structured prompts for a team briefing or debriefing. Or they may be a combination of all three. Checklists were first introduced in aviation in the 1930s to address human error, as newer more complex aircraft were introduced, and are now common in high-risk industries. Much is known about checklist development from industry—for example, checklists should ideally be one page, use simple familiar language, and each element should contain no more than five to nine items.
Checklist design requires consideration of content, format, timing, trial, and feedback, followed by formal testing and evaluation. Checklists should be evidence-based and address key safety items that are often overlooked, and which, if omitted, would lead to serious adverse outcomes. By standardizing performance, checklists reduce reliance on memory and thus reduce errors of omission. This is particularly applicable to healthcare as processes become more complex, staff become busier, and handovers and shift working become more common. Checklists contribute to team communication and working and increase situational awareness among team members, but successful adoption requires careful implementation to make sure that the checklist is used effectively.
There are clearly differences between healthcare and ultra safe industries such as commercial aviation, and some of these differences may be a significant barrier to using the same techniques at risk reduction. For instance, clinicians typically value clinical autonomy and view themselves as individual craftsmen rather than members of a team after standard operating procedures. These differences help to explain why the implementation of checklists and routine adoption of safety briefings in healthcare may not be straightforward.
