The article published in this issue of Academic Radiology describing PRODUCT reports the outcome of a fluoroscopy checklist and also contains a discussion of the use of a fluoroscopy checklist based on a pneumonic. In fact, checklists have been increasingly used in medicine for the following reasons. First, their purpose is to prepare the stage so that a critical step in a procedure is not omitted. Second, a checklist ensures that practice guidelines are introduced and followed. Guidelines can be established by analyzing the essential and universal actions of experts in performing a task. It is important that several experts are interviewed or watched as there are often steps inserted for reasons of superstition but which are not critical to the outcome of a process. And third, a checklist ensures that a step that is necessary is not omitted. This last item is particularly important in the case of an overly confident novice or in a tedious procedure, where the obvious may be omitted or forgotten because it is obvious to ensure outcome.
Checklists represent a form of task analysis in which the obvious is often incorporated with the not so obvious to ensure that steps are not forgotten. Thus, checklists initially were an air safety procedure to ensure that a step was not omitted and that standardized guidelines were followed. Therefore, checklists can exist to standardize actions, incorporate guidelines, and avoid omission of a key point. Checklists are also useful for self-checking of performance, self-assessment, and self-evaluation. What better way to organize the approach to a problem and to support success than to have the necessary steps readily available to the learner.
There are several inherent problems with guidelines. One is that in the rush of excitement, as in an emergency situation, the checklist may not be available or may not pertain to the situation at hand. Because checklists are a weak replacement for common sense, they do not belong in every situation. If dependence on a checklist is strong, it may actually hinder performance in a time-critical situation. This is often the case in a medical emergency, unless there is someone present who has been especially trained in an essential procedure. This situation supports simulation training of key medical personnel to respond to an emergency situation.
Reference is often made to the story of successful resuscitation of a child who was submerged in frigid water for a period. It was essential to her successful survival that key services in the destination hospital be prepared for her arrival, and a very simple solution to this problem was to notify the hospital with communication about the situation and expected arrival time to avoid the inevitable “last-minute” rush to prepare for the necessary and some unnecessary procedures .
Checklists have been showing up in critical care and surgery recently as a useful quality improvement and quality assurance measure.
In 2001, Peter Pronovost, a critical care and anesthesia specialist, gave the idea a try. He designed a checklist to address only one problem: line infections.
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References
1. Leschied J.R., Glazer D.I., Bailey J.E., et. al.: Improving our PRODUCT: a quality and safety improvement project demonstrating the value of a preprocedural checklist for fluoroscopy. Acad Rad 2015; 22: pp. 400-407.
2. Gawande, A. The Checklist; if something so simple can transform intensive care, What else can it do? The New Yorker Magazine 2007 Annals of medicine, December 10, 2007. Available at: http://www.newyorker.com/magazine/2007/12/10/the-checklist .
3. The Checklist Manifesto: How to get things right. Jan 4, 2011 by Atul Gawande, Metropolitan Books, Henry Holt and Company LLC, New York, NY ISBN 978-0-8050-9174-8
4. Gawande, A Op-Ed Contributor A Lifesaving Checklist Bottom of Form. Available at: http://www.nytimes.com/2007/12/30/opinion/30gawande.html?pagewanted=all ATUL GAWANDE Published: December 30, 2007 Boston.
5. Pronovost, P., Vohr, E., Safe patients, smart hospitals: how one doctor’s checklist can help us change health. 2010
6. Urbach D.R., Govindarajan , Saskin R., et. al.: Introduction of surgical safety checklists in Ontario, Canada. NEJM 2014; 370: pp. 1029-1038.
7. Bergs J., Hellings J., Cleemlput I., et. al.: Systematic review and meta-analysis of the effect of the World Health Organization surgical safety checklist on postoperative complications. BJS 2014; 101: pp. 150-158.