If pilots took the same approach to flying that is commonly taken to medicine, no one would want to board a plane; there would be far too many plane crashes. That is the conclusion Dr. Atul Gawande and others arrived at after studying the use of checklists in different “mission critical” businesses.
For history buffs, checklists were first developed for pilots in the 1940’s after the B17 was introduced, and crashed on it’s first flight. An investigation found that the complexity of flying the new aircraft overwhelmed pilots. After a checklist was introduced in the cockpit, B17s took off and landed thousands of times without a crash attributed to pilot error.
A recent study from the Journal of Patient Safety found the number of US patients who suffered a preventable harm that contributed to their death in 2013 may be as high as 440,000. In 2013, only three people died in the US in plane crashes.
The fact that hundreds of people might perish from a single plane crash while only one dies when a surgery goes sideways is small consolation when you are the one.
As simple as it is, the WHO surgery checklist (published in 2008) is now seeing wider adoption rates and is being modified to fit specialty surgeries and specific hospital needs. This document is in three sections: ‘Sign In,’ ‘Time Out,’ and ‘Sign Out’. Each of these sections corresponds to a separate phase of the surgical process. ‘Sign In’ is done before anesthesia, ‘Time Out’ before incision, and ‘Sign Out’ before the patient leaves the operating room. View the checklist here.
Also available online are the modified where modified WHO surgery checklists. These checklists were created and modified for specific countries and specific surgical uses. You can view these checklists here. These examples demonstrate not only how the basic format is modified to meet local needs, but also how to introduce surgical checklists to patients and staff.
It was recently pointed out by a study in the Netherlands that having this documentation can make a big dent in malpractice claims by standardizing the surgical process. The study showed that nearly one third of malpractice claims arose from mistakes that likely would have been caught on a checklist.
With HarmoniMD Mobile, our tablet based EMR, surgical checklists are available on a tablet computer and can be augmented with hospital specific information such that the surgery can be documented within the checklist environment. Better yet, the tablet can also be used to take photos of the surgery and the equipment used, creating a visual documentation of the entire process.
Our mission is to advance global health with affordable mobile computing, and surgical checklists are one of the tools we use to accomplish this. Please join us.