Here is a link to the actual checklist:
https://apps.who.int/iris/bitstream/handle/10665/44186/97892...
I'm a bit perplexed that something so simple, can reduce post surgical deaths by a third.
https://apps.who.int/iris/bitstream/handle/10665/44186/97892...
I'm a bit perplexed that something so simple, can reduce post surgical deaths by a third.
For example, why would you need everyone in the room to say their name and what they do?
Simple: everyone is wearing a mask and often surgical scrubs that are the same color. By having everyone say "Hello, my name is Dr. Jones and I'm the anaesthesiologist" you can quickly determine who is the person to direct questions to about the patient being under.
It gets even crazier when you hear stories about doctors going into the wrong operating room (especially at bigger hospitals where there are several ORs). A simple "State who you are and why you are here?" costs very little and helps avoid costly mistakes.
Another example: having a checklist allows a junior person (e.g. a nurse) to challenge more senior people when they make a mistake.
Example without checklist:
Nurse: Dr, I think you forgot to do X.
Dr: I know what I'm doing, don't question me.
Example WITH checklist:
Nurse: Dr, you missed step #4.
Dr: I'm sorry, you are correct. We all agreed that was a necessary step and I missed it.
As have others in sibling threads, highly recommend Gawande's Checklist Manifesto.
Example without checklist: Nurse: Dr, I think you forgot to do X. Dr: Oh, you are right, thanks a lot
Example with checklist : Nurse: Dr, you missed step #4. Dr: I have done this list every day for the past 15 years, I know I ddid not forget anything, don't question me
My understanding is that if the checklist empowers, say, 5% of the nurses to speak up and 5% of surgeons to acknowledge the error that is still a huge net positive over thousands of cases.
My favorite small nudge example is pill bottles vs "blister" packs. Having pills in blister packs has shown to have a significant effect on reducing suicide as it makes it much harder to get the number of pills needed. Yes, some people will still succeed but there is a segment of the target population who will give up after a couple pills.
But medical school is going to heavily select for conscientiousness (a personality trait that checklists work with), and also checklists are essentially another authority in the room.
So, yes, you could potentially have discussions over whether or not something has actually been done. But you aren't going to have discussions about whether it should be.
You're not wrong, but if the hospital policy is to follow checklists, then the doctor overriding it would have to answer some questions afterwards if something were to go wrong.
Presumably a review would occur, and the fact that the checklist was ignored could be used as 'evidence' against the doctor.
If a junior person thinks that a senior person is about to make a terrible mistake, then the word "Stop!" should be used, along with the reason. That word will often make even the most arrogant person pause and think about what they are doing.
Expertise and practice makes some of those things automatic, but not enough to reduce it all below 5-7. Further, in any surgery there will be other things going on that require cognitive attention, decreasing capacity for other things.
Everything you can do to reduce cognitive overhead makes a process smoother.
I teach the LSAT. One section logic games (officially, analytical reasoning) tests precisely this cognitive load. Students must work with 4-6 rules + what the situation calls for on question.
The rules are impossibly simple. But, in the heat of things, students just aren't capable of working with that many items unless they create a structure using diagrams. And even seemingly tiny efficiencies have an outside effect on speed and correctness.
Don't forget that these surgeons are often tired busy and stressed, three factors that worsen performance. Having a clear list that says "do this now dummy!" massively helps keep you on track even when you're a wreck.
It's like help desk asking you if it's plugged in. You may think of yourself as a technical person and that the problem is more complex like the driver isn't loaded or the monitor isn't properly configured but the problem could just be that you forgot to plug the video cable in. Just having those basic checks occur before anything can go wrong makes it so that when things do go wrong, time doesn't need to be wasted on going over the simple stuff or even worse, forgetting about the simple stuff and going down the wrong route.
Because it didn't. It attributes the entirety of a decade long decline to the check list, which is obviously nonsense. I'm not saying that checklists aren't good, but they're not miracle workers.
>After testing, review and feedback from health boards across Scotland, the surgical checklist was included as one of the ten Patient Safety Essentials to be implemented across all health boards in Scotland37. The surgical checklist was not a stand‐alone intervention. It was, however, the only Patient Safety Essential that targeted surgical patients specifically during the interval studied37. Thus, the addition of the checklist to the other parameters within the SPSP may have contributed to the improvement in results observed in the present study.
>It is acknowledged that attributing causal links to the findings in population‐wide data set analysis is not possible.
What you said they didn't do is kind of exactly what they did. Yes, there is some attempts at hand waving, but it's silly to boil down the success of a large and multi pronged program to a simple checklist.
That's hardly hand-waving.
Here's the 10 safety essentials check list they are talking about:
http://www.healthcareimprovementscotland.org/news_and_events...
If the checklist is responsible for all of the improvement in surgical outcomes then we can stop doing the rest of the stuff, right? No need to emphasize hand washing or sterile central line because the magic checklist will stop the infection.
Here's a link to the study.
Please point out the parts of it that you find to be scientifically failing.
There's a valid point to be made that the original article implies a greater causal link than the study, but that isn't the study's fault, and it doesn't actually diminish the effect of the checklist in the process. Poor reporting on science is always a problem, and journalists typically use layperson phrasing in order to make the information more consumable.