Comments on: A Simple Checklist Does Wonders in Improving Surgical Outcomes

By: Greg

Greg — Tue, 20 Jan 2009 12:48:41 +0000

Sounds like cookbook medicine. I can see how using a checklist can make one feel that the procedure is automated and that you are simply a part in the machine. However, I have been in these settings and I can say that communication can be surprisingly poor. It is especially galling when I ask for a medicine to be administered and there is no feedback that it has been given so I am not sure where I am at with the total dose given to the patient. After having to ask for the 10th time whether or not the drug has been given I sometimes get frustrated enough to stop asking for confirmation. Speaking to the person afterwards usually doesnt stop the behavior for the next procedure. Making the feedback process part of hospital protocl would solve that kind of problem. Since two or more heads are better than one I can see the value of breaking potentially intimidating authoritarian air that ices the OR and allowing others to speak up when they think they see something amiss. I have found that more than half of the time when somebody speaks up they are right. Some potentially embarassing mistakes have been prevented by such observations. So even though such procedures may be seen as silly and limiting like using a cookbook, there is a reason why people still use recipes since following them prevents mistakes from being made and steps from being missed. The next time you fly in a plane you can be thankful that the pilots who opposed checklists were silenced and the phenomenal improvement in flying safety that has been the result.

By: DrSparkey

DrSparkey — Fri, 16 Jan 2009 17:41:34 +0000

A similar “ego” problem was solved in the airline industry. Surgeons and Pilots have similar psychological profiles. Aggressive, assured, self confident, use of intimidation against peers etc. FAA and the airline industry found in investigating airline accidents, that lack of cockpit cooperation, lack of anticipation of what to do next, …the other pilot was supposed to do something….was a heavy contributor to accidents. So a protocol was born called Cockpit Resource Management defining how the pilots work together and in which ways.

This CRM protocol is now standard among most airlines in the world

By: Dan Walter

Dan Walter — Fri, 16 Jan 2009 12:37:48 +0000

Good thing you went to Baylor instead of Johns Hopkins Cardiology. Read what could have happened to you during a catheter ablation procedure at “America’s Best Hospital”: http://adventuresincardiology.com

or Google “Adventures in Cardiology”

By: bigjohn756

bigjohn756 — Thu, 15 Jan 2009 22:31:00 +0000

I was at Baylor Hamilton Heart & Vascular Hospital a couple of weeks ago for an EP study and ablation procedure. As soon as I entered the operating room I was introduced to everyone and questioned thoroughly about everything; my name birth date, why I was there(the form was not correct so they updated it and I initialed it), etc. etc. I don’t know if there were nineteen steps but it seemed like almost that many. During the procedure communications between all the personnel was clear, crisp and very professional. I was impressed.

By: Bob Snyder

Bob Snyder — Thu, 15 Jan 2009 19:17:17 +0000

Sorry, I meant Dustin.

By: Bob Snyder

Bob Snyder — Thu, 15 Jan 2009 19:16:40 +0000

You’d think that they would already have pre-surgery checklists in most hospitals. Now I could see if the checklists differed from one hospital to the next but to not have one at all? I just had ACL reconstruction last week and was asked 3 times by different people which leg it was and it was marked as well before the surgery. I would have to agree with Damien on this one… I doubt that surgeons feel that this would “de-professionalise” them, more than likely it’s probably their ego getting in the way.

By: William

William — Thu, 15 Jan 2009 18:25:02 +0000

Check lists are used before any important matter Space flight, leaving for the office and now surgery.
I would have thought that would have been one of the first things to do as I think that it is important to cut off the correct leg and other smaller things even the question “is the patient facing the right way”.
At last some one with common sense which I have been informed is not that common.

By: Dustin

Dustin — Thu, 15 Jan 2009 18:22:43 +0000

“Some surgeons say that checklists de-professionalise them, turning them into automatons who don’t think”…

Do you think these same surgeons would feel more comfortable flying on a plane in which the airlines/regulatory agencies do not require the pilots to use pre-flight checklists?

Process-based activities benefit greatly from checklists. Any surgeon who doesn’t see that should get an eg0ectomy.

By: Mandy

Mandy — Thu, 15 Jan 2009 15:53:02 +0000

The checklist is composed of 19 fairly obvious items, but lead researcher Atul Gawande says that even a small change, like having surgical team members take a moment to say who they are and what they do before scalpel touches skin, can have important consequences later on should one of them develop a concern during the operation. Earlier studies have shown that communication problems are fairly common in operating rooms, with junior members of the team sometimes hesitant to speak up.