Medical Checklists Needed to Improve Care and Outcomes

Johns Hopkins authors advocate medical checklist use and propose a process to develop them
By Jeff Muise
HealthDay Reporter

MONDAY, Feb. 22 (HealthDay News) -- The checklists so common in aviation and many professions are underused in medicine and, if more widely adopted, would provide powerful tools to standardize care and improve patient outcomes, according to an article published Dec. 31 in Critical Care.

Bradford D. Winters, M.D., of Johns Hopkins University in Baltimore, and colleagues surveyed the current usage of checklists in medicine and found the practice limited to the operation of equipment in certain clinical settings (such as the intensive care unit) or in specific treatment algorithms. Meanwhile, the obstacles to medical checklist use include professional resistance and the slow process of knowledge dissemination. Based on checklist development in aviation and human factors engineering, the authors proposed a process for medical checklists.

The authors' proposed checklist development process includes: base checklist design on the users' needs and the realities of their work (include users on the design team); list critical items first; avoid long checklists, if possible, and break-up necessarily long checklists into sub-sections; emphasize usability, including how long it takes to complete the checklist; conduct pilot tests of new checklists; and periodically re-evaluate and update checklists.

"Checklists are powerful tools to standardize work processes and create independent checks for key processes. Although they can have wide application in medicine, they are relatively underused. Checklists could create a more efficient and effective knowledge market by summarizing evidence into explicit behaviors, incorporating empiric and tacit evidence, and being continually updated by the health care community," the authors conclude.

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