Checklists used during rare surgical emergencies help to avert disaster, according to Atul Gawande, MD, MPH, a surgeon at Brigham and Women's Hospital in Boston and renowned author of The Checklist Manifesto.
In a study published in the New England Journal of Medicine, Dr. Gawande and colleagues report that 17 OR teams that used checklists during 106 simulations of surgical crises such as cardiac arrest, air embolism, anaphylaxis, and hemorrhage were 75% more likely to perform 47 key life-saving steps in care than those who managed the staged emergencies from memory alone. Nearly all of the caregivers in the study said they would want emergency checklists used during cases in which they were patients.
Even though the use of checklists have been proven to improve surgical safety, Dr. Gawande sees frontline compliance falling short due to surgeons and surgical teams who balk at the added time needed to incorporate the tool into established perioperative routines.
He believes checklists are essential patient safety tools, even if the core values they promote — humility, teamwork and discipline — often run counter to the surgeon-led team model ingrained in most ORs.
"Four years ago, we showed that completing a routine checklist before surgery can substantially reduce the likelihood of a major complication," he says. "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."
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