I've just finished reading this book by Atul Gawande, the third book of his which I've read. He is a surgeon in Boston who lectures and teaches widely on patient safety and improving medical healthcare. His first two books 'Complications' and 'Better' looked at some of the common problems encountered in modern medicine and the stories of people trying to improve care.
This third book looks specifically at 'the checklist'. Atul Gawande was one of the team of professionals who helped develop the WHO Surgical Checklist - certainly as far as I'm aware, one of the best examples of how a simple checklist can help to make medicine safer. One of the chapters does focus on the WHO Surgical checklist including it's success and some of the barriers which had to be overcome for its implementation. But this book is not just about the WHO Surgical Checklist. He draws on examples from other professions, such as architecture, finance and the airline industry to show how simple checklists can help to ensure that in complex situations, important simple considerations are not forgotten, helping to reduce the frequency of errors.
The thing about checklists is that they are easy to create and design. All it takes is to look at errors which have been made and then try to put checks in place to stop them from happening. The difficult part is bringing them into practice, proving that they make things safer, overcoming the skeptics (there are always some!) and figuring out when and where to use these checklists. They also have to be designed in such a way that they are easy to use: not too long, not too short, readily available, with clear instructions about who is to use it and at what time. Is it a 'read-do' checklist (ie. do each task as the checklist is read), or a 'do-confirm' checklist (one where the task is completed and someone checks off the list that nothing has been missed). The results from the WHO surgical checklist in its initial trials were astonishing and Atul Gawande recalls in the final chapter about one of his patient's lives was saved when a check on the surgical list ensured that cross-matched blood units were available ('just in case') and a patient had a large unexpected haemorrage intra-operatively.
Checklists are starting to be introduced into medicine in the UK. A perfect example of how a checklist is being used in hospitals in Scotland is the 'Sepsis 6' checklist - a list of 6 simple tasks (oxygen, antibiotics, urine output monitoring, blood test for lactate level, intra-venous fluids and blood cultures) which should be completed in one hour for all patients diagnosed with sepsis - a common problem with a high rate of mortality if not treated rapidly.
The best way to introduce a checklist is via a small tests of change: 'plan, do, study, act' cycles. A checklist always requires modifications in the initial stages and testing in small numbers of patients at a time enables these tests to be observed. At the moment I'm trying to help introduce a 'ward-round checklist' in the medical wards to be used by doctors on ward rounds. I'd strongly recommend this book to anyone interesting in patient safety improvement.
