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Checklists may help in operating room emergencies: study

Source: Thomson Reuters Foundation - Thu, 17 Jan 2013 12:17 AM
Author: Reuters
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Jan 17 (Reuters) - Having step-by-step checklists on hand may help doctors and nurses better manage emergencies in the operating room, according to a U.S. study.

Those lists can save time and brainpower in situations such as when a person's heart stops beating on the operating table or a patient begins bleeding uncontrollably, researchers wrote in the New England Journal of Medicine.

"The standard practice across the country has just been, you work from memory and reason your way through a crisis," said Atul Gawande, from Brigham and Women's Hospital in Boston, who worked on the study.

"People have called (checklists) 'dumbing down' medicine, but what we showed is that even in this incredibly stressful, high-complexity situation, the teams that worked from a kind of pre-planned set of steps had three quarters lower likelihood of missing critical lifesaving steps," he told Reuters Health.

For example, in a case where a patient's heart slowed way down, "you weren't racking your brain to remember what the setting was supposed to be on that external pacemaker," Gawande said. "Instead you were focusing on,'What else am I not thinking about here?'"

For the study, he and his colleagues arranged 17 operating room teams to go through 108 simulated surgical crises, with or without the checklists. They found that with the lists, the proportion of essential steps missed during emergencies dropped from 23 percent to six percent.

Every team did better when it had the crisis checklists on hand, and Gawande said his own hospital and a few others have started making such emergency checklists standard procedure in the operating room.

Past research by his team showed that using pre-surgery checklists also helped prevent problems in the first place.

"Previous checklists made sure things went well for cases we do every day," said Douglas Paull, a surgeon at the Veterans Health Administration's National Center for Patient Safety in Ann Arbor, Michigan, in an email to Reuters Health.

"Now (there are) checklists for crisis to make sure critical actions occur in timely fashion."

Checklists have come into greater use in recent years, with programs showing that their use can reduce errors and infections, but the researchers said some doctors and hospitals may still be hesitant to start using them.

"There is a huge issue of, 'Good people would remember this, they don't need a checklist," said Paul Preston, an anesthesiologist from Kaiser Permanente San Francisco who is leading efforts to get checklists into Kaiser Permanente operating rooms.

The study authors noted that their research was done in simulated situations, so they can't be sure that would happen in a real emergency. Still, almost all doctors and nurses involved in the simulations said they would want a checklist if one of those crises took place during an operation.

"The biggest difference in the survival from surgery between hospitals is in whether they're able to rescue people from complications," Gawande said. SOURCE: http://bit.ly/13EAAZx (Reporting from New York by Genevra Pittman at Reuters Health; editing by Elaine Lies)

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