OR checklists improve adherence to evidence-based guidelines

Checklists help to keep many on task during their normal routines. In the operating room, where adherence to standardized sets of evidence-based guidelines is critical, checklists can be life saving, according to research published Jan. 17 by the New England Journal of Medicine

“Checklists have long been accepted in other high-risk industries as a tool to aid performance during rare and unpredictable critical events,” wrote lead author Alexander F. Arriaga, MD, MPH, ScD, of the department of health policy and management at the Harvard School of Public Health in Boston. “In the field of medicine, the use of surgical safety checklists during routine operative care has been associated with significant reductions in morbidity and mortality among and is rapidly becoming a standard of care.”

To determine the effect of checklists on adherence to best practices, researchers conducted surgery simulations with operating room teams consisting of anesthesiologists, nurses, surgical technologists and a mock surgeon at three Boston-area hospitals from August 2010 through December 2011. A series of crisis scenarios were presented to each team, who had previously developed sets of checklists available during half of the scenarios.

The researchers assessed a total of 17 operating teams during a total of 106 simulations according to 47 life-saving processes derived from evidence-based guidelines.

They determined that using checklists resulted in nearly a 75 percent reduction in failure to adhere to evidence-based guidelines. When study participants had checklists available, they skipped life-saving steps 6 percent of the time compared to 23 percent of the time when checklists were not available. These results remained similar regardless of the scenario, according to Arriaga et al.

“Critical events in high-risk professions call for rapid, coordinated and accurate maneuvers, despite stress and increased task load, as a requisite for successful management,” they concluded. “In a setting where time-sensitive appropriate care is essential, this intervention has the potential to meaningful affect clinical practice and surgical outcomes.” 

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