The Use of Checklists in Medicine

Can We Apply this to Ultrasound Training?

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Laura Q1

Journal Club - Summary

Introduction:

Checklists are not a new concept and have been used in countless scenarios for hundreds of years. Standardised checklists were famously formally adopted by the aviation industry around 70 years ago in light of the increasing complexity of aircraft. Their introduction successfully minimised or even eliminated human error. The checklists defined the process path to achieve optimum flight performance in every circumstance, whether normal or emergency.

With the ever-increasing complexity of medicine, combined with the inescapable potential for human error, checklists have been increasingly adopted in human medicine to great positive effect.

Studies discussed:

In one multicentre prospective cohort study, the median rate of catheter-related bloodstream infections were reduced from 2.7 per 1000 catheter days to zero after 3 months, and thereafter maintained for 15 months following the introduction of an intervention which included a defined checklist.1 Although the study design couldn’t categorically identify a causal relationship, the results indicated that the implementation of a checklist with training was effective at reducing morbidity. A 19-point surgical safety checklist implemented in eight hospitals in eight different countries reduced patient mortality from 1.5% to 0.8%, and the complication rate from 11.0% to 7.0%.2 This was a checklist centred around operating room procedures only. Another study focused on the use of checklists which targeted the entire surgical pathway, including the pre-operative and post-operative phases.3 In-hospital mortality was reduced from 1.5% (in agreement with the previous study) to 0.8%, and complication rate decreased from 27.3% to 16.7%.

Conclusions:

Medical checklists can be effectively used to define a standard evidence-based pathway or procedure, facilitate teamwork, reduce the chance of error or missed steps, and rely less on the memory of staff, including the negative effects of workplace-stress, tiredness, and time-pressure. Incomplete or non-systematic evaluation of the abdominal organs is likely to be an important cause of incomplete abdominal ultrasound evaluations which may lead to missed information (personal observations). Difficulty in recall of normal measurement values may also contribute to difficulties experienced. The use of a checklist may go some way to reducing this error, especially for relatively new or occasional ultrasound-users. We have developed an abdominal ultrasound checklist which we are now distributing to everyone who attends our abdominal ultrasound courses, and which can be freely accessed and used by anyone! Equally important to the checklist itself is consistent compliance with its use; download your copy now and see if it can transform your abdominal ultrasound evaluations!

  1. Pronovost P., Needham M.D., Berenholtz S. et al. (2006) An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med 355: 2725-2732.
  2. Haynes A.B., Weiser T.G., Berry W.R. (2009) A surgical safety checklist to reduced morbidity and mortality in a global population. N Engl J Med 360: 491-499.
  3. De Vries E.N., Prins H.A., Crolla R.M.P.H. (2010) Effect of a comprehensive surgical safety system on patient outcomes. N Engl J Med 363: 1928-1937.

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