Checklists: A Tool to Improve Function

Lee Herold, DVM, DACVECC, explains how checklists can improve the efficiency and safety of many medical systems. A sample surgery checklist template from the World Health Organization is included in the print version PDF.

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Many of the tasks we perform daily in veterinary medicine are systematic--we perform physical exams in the same sequence every time, we chart notes in a SOAP format, we generate diagnostic and therapeutic plans based on differential lists. These tasks are all examples of informal checklists that we “check off” in our heads as they are completed. Whereas these informal checklists are performed without a second thought to them being an itemized list, the use of more formalized checklists in different aspects of medicine has been shown to improve outcomes.

There is convincing evidence that with the publication and implementation of the World Health Organization’s Safe Surgery Checklist, outcomes and survival were improved and surgical complications reduced. With implementation of simple ICU checklists, hospital acquired infection rates are reduced. These checklists have been shown to be simple to use, and not time consuming. Despite evidence of improved survival and outcomes with the use of checklists, there remains resistance to their use from the medical community. Many of the arguments stem from bruised egos-“I know what I’m doing and don’t need a checklist to tell me.” Another common excuse is “I’m too busy” stemming from the perception that checklists are simply another administrative hoop to jump through when they are already so busy with their jobs. It is difficult to get away from this dogma in medicine as most of us in this profession are highly educated, intelligent individuals and with a fair share of large egos and stubbornness in that mix as well. However, as medical professionals we are also obligated to look at the literature and change our actions based on available evidence. Isn’t that part of the veterinary oath?...“I accept as a lifelong obligation a continual improvement of my knowledge and competence.” I would argue that the benefit of the use checklists outweighs any perceived slight to our egos. By our nature as scientists we are drawn to the advancements in medical and diagnostic technologies that can save or extend lives, but I can’t see turning a blind eye to something so simple that has been shown to save lives--even if it is low tech.

The use of checklists does not need to be limited to surgery or the ICU, they can be used in many areas of our hospital including in ensuring quality control for our in house lab tests when we run daily controls checklists, to standardize the training of our new employees to ensure they have the tools needed to be successful at their jobs, in inventory management, in ensuring that daily hospital cleaning and restocking is performed and in many other aspects of the running of our hospitals. The use of checklists can improve the success of critical or even mundane daily tasks.

Consider evaluating procedures in your hospital that occur daily and developing checklists to ensure that they are performed systematically every time. I know some will say, “Well I have a great technician who does it perfectly and the same way every time.” However what happens when that technician calls out sick or you have to train someone new? Checklists can ensure that a sequence of events is followed closely or that communication between team members is clarified. Checklists help ensure that you have the means to complete any task with the same high quality every time.

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