Using checklists during an operating room crisis has the potential to markedly improve care and safety.

With important tasks at hand, many people find checklists useful in getting the job done. But what about a hospital operating room staff using a checklist in crisis situations?

Brigham and Women’s Hospital (BWH) researchers, along with colleagues at the Harvard School of Public Health, have released a study showing that provider teams that use a checklist in the operating room (OR) were 74 percent less likely to miss key life-saving steps in care during an emergency situation.

“For decades, we in surgery have believed that surgical crisis situations are too complex for simple checklists to be helpful. This work shows that assumption was wrong,” says Dr. Atul Gawande, a BWH surgeon, senior author of the study and author of the book, The Checklist Manifesto.  (Surgical crises include complications such as cardiac arrest or excessive bleeding or hemorrhaging.)

In this study, researchers recruited 17 OR teams, including anesthesia staff, OR nurses, surgical technologists, and a mock surgeon to participate in over 100 simulated surgical crisis scenarios. Half of the scenarios had a set of crisis checklists and the remaining scenarios were managed from memory alone.

Dr. Gawande says, “Four years ago, we showed that completing a routine checklist before surgery can substantially reduce the likelihood of a major complication. This new work shows that use of a set of carefully crafted checklists during an operating room crisis also has the potential to markedly improve care and safety.”

In response to the study, BWH has committed to implementing these checklists for the safety of patients and to evaluate the effect they have on care.


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