Can Aviation-Style Checklists Work in Medical Settings? - 8/3/2017 Barbara Burian Checklists, ubiquitous in high-stakes work domains such as aviation, are increasingly being adopted across diverse medical specialties and settings. Despite the general success of checklists in aviation, researchers and practitioners are discovering that checklist efficacy is not as high as hoped for within medicine (Prielipp & Coursin, 2015, Grigg, 2015). One of the reasons for this is a mis-match between the checklist and the medical setting in which it is used. Medical checklists were initially developed as a way to copy the success of aviation checklists in improving flight safety (Bloomstone, 2015; Gawande, 2010; Thomassen et al., 2011; Hales & Pronovost, 2006); consequently, the designs of many medical checklists mirror that used in aviation. However, this makes them less effective, more cumbersome, and less likely to be accepted by medical personnel because the two work domains have different task structures, team responsibilities, and environmental settings. We compare the two settings in Table 1 (see also Durso & Drews, 2010):Table 1. Aviation and Medical Settings
Aviation is highly structured, and much of the time it is relatively predictable. In contrast, the medical environment—whether it is an operating room, procedure suite, or clinic—is much more fluid, and unforeseen events happen regularly. A team of two professionals who have identical training (i.e., pilots) and who work together throughout a procedure (i.e., flight) is much easier to organize through a checklist than a team of many people with varying skills and levels of training, who come and go at different times during a procedure (e.g., surgery). Additionally, a critical event in the operating room is always mediated by patient-specific factors, such as age, comorbidities, allergies, genetics, and lifestyle. Also, details of physiological events may vary considerably. In contrast, the variability associated with a specific kind of critical event in a given aircraft type (e.g., Boeing 737) and the responses required are generally far more constrained. To be effective, a checklist must reflect the reality of the specific environment in which it is used and the task demands encountered. References Bloomstone J. (2015). Humans fail, checklists don't. J Clin Anesth Manag. 1(1): 1-3.Burian, B. K. (2014). Factors affecting the use of emergency and abnormal checklists: Implications for current and NextGen operations. NASA Technical Memorandum, NASA/TM—2014-218382.Burian, B.K., Clebone, A., Dismukes, R.K., & Ruskin, K. (in press). More than a tick box: Medical checklist development, design, and use. Special Article. Anesth Analg. Durso F, & Drews F. (2010). Health care, aviation, and ecosystems: A socio-natural systems perspective. Current Directions in Psychological Science. 19(2):71-5. Gawande A. (2010). The checklist manifesto : How to get things right. New York: Metropolitan Books. Grigg E. (2015). Smarter Clinical Checklists: How to Minimize Checklist Fatigue and Maximize Clinician Performance. Anesth Analg. 121(2):570-3. Hales BM, & Pronovost PJ. (2006). The checklist--a tool for error management and performance improvement. J Crit Care. 21(3):231-5. Prielipp RC, & Coursin DB. (2015). All That Glitters Is Not a Golden Recommendation. Anesth Analg. 121(3):727-33. Thomassen O, Espeland A, Softeland E, Lossius HM, Heltne JK, & Brattebo G. (2011). Implementation of checklists in health care; learning from high-reliability organisations. Scand J Trauma Resusc Emerg Med.19/1/53:1-7. |
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