Surgical checklists

Checklists do not work for surgery

checklist

A few years ago a a book came out that made a big splash called ” The checklist manifesto” by Dr. Atul Gawande.

The premise of the book was that having checklist will decrease errors in surgery. The prime example given was that of airline pilots who run a checklist before every flight.

Everyone started to make checklists for everything- and to a great extent they do work. The work for airline pilots, fr inventory and distribution of products etc. They do not work for surgery, as a recent study in the New England Journal of Medicine has shown.

“There may be value in the use of surgical safety checklists, such as enhanced communication and teamwork, and the promotion of a hospital culture in which safety is a high priority; however, these potential benefits did not translate into meaningful improvements in the outcomes we analyzed,” they reported.

… and all this despite the fact that this study, was conducted in over 90 hospitals in Canada with over 91% compliance, and covering 200,000 surgical procedures. No difference in mortality or complications occurred as a result of use of checklists.

Surgical checklists

One of the themes of “The checklist manifesto” was that checklists would prevent complications and standardize protocols. Other research has shown that in a hierarchical grouping of people, such as with airline pilots where the captain is all knowing, members of the group will rarely question decisions of the group “leader”.

In many hospitals, the  group”leader” (surgeon) in the operating room still cuts the wrong leg off or operates on the wrong side of the brain because other group members ( anesthesiologists, nurses and techs) do not question the decision and authority of the surgeon.

Still, why do checklists not work in the operating room or in medicine? I don’t know! They should!