By Sean Power

First Posted at Physician-Patient Alliance for Health & Safety on 3/19/2013

Sean Power, Community Manager, Physician-Patient Alliance for Health & Safety

Patient safety checklists help to make sure no procedural step is forgotten. According to the Agency for Healthcare Research and Quality, checklists are theoretically sound and have contributed to advances in patient safety. As AHRQ states:

Although a seemingly simple intervention, checklists have a sound theoretical basis in principles of human factors engineering and have played a major role in some of the most significant successes achieved in the patient safety movement.

Below we’ve outlined some of the benefits of adopting patient safety checklists in your health care facility.

1. Checklists provide a sense of confidence that you’ve taken all the right steps.

At the recent Patient Safety, Science & Technology Summit, Peter Pronovost, MD, PhD, FCCM(Professor, Departments of Anesthesiology/Critical Care Medicine and Surgery, The Johns Hopkins University School of Medicine and Medical Director, Center for Innovation in Quality Patient) recommends translating evidence into practice (TRiP). This process involves four steps:

  1. "The value of medical checklists lies in their concise consolidation of a considered body of knowledge in one simple document." -Eric Coleman, MDSummarize the evidence in a checklist.
  2. Identify local barriers to implementation.
  3. Measure performance.
  4. Ensure all patients get the evidence.

The TRiP process makes sure that evidence guides decisions. Checklists summarize the evidence-based decisions that health care providers will have to make when caring for patients.

In other words, following patient safety checklists ensures decisions are in line with what medical evidence shows will result in the best outcomes.

2. Checklists are effective at reducing medical mistakes.

Studies show that checklists can improve patient outcomes in fields ranging from plastic surgery to obstetrics and gynecology. Hospitals and other healthcare facilities looking to eliminate complications and mortality should consider checklists as part of their patient safety program.

On the Katie Couric Show, “Shocking Medical Mistakes“, Dr. Pronovost stated that preventable medical mistakes are the third leading cause of death in the United States.

Simply put, checklists prevent adverse patient outcomes and reduce medical mistakes.

3. Reducing medical mistakes lowers litigation costs.

Researchers calculate that hospitals spend between $2.7 million and $13.5 million on malpractice litigation. Reducing the number of adverse events in turn will lower litigation costs.

Moreover, Dr. Pronovost’s TRiP process, described earlier in this article, emphasizes explaining the evidence behind decisions to patients. A study published in the Cleveland Clinic Journal of Medicine found that many patients who sought attorneys complained that they had never received a satisfactory explanation from the physician for why the adverse event occurred, compounding the original problem.

Improving the physician-patient relationship by communicating that an error occurred despite the use of the latest checklists may help diffuse situations and avoid litigation.

4. Checklists provide technical solutions for technical problems.

Checklists are proven to reduce medical mistakes but cannot eliminate all obstacles to safe patient care. The Lancet suggests that successful checklist adoption is impeded by social and cultural factors. For example, some physicians may claim they undermine specialized expertise. Others might claim checklists prevent swift decision-making. Despite these objections, introducing the idea of a checklist can still be a good first step and spark discussion that breaks down these obstacles to patient safety. Checklists provide concrete action items that solve specific problems.

Checklists alone do not overcome these socio-cultural barriers. Hospitals and other healthcare facilities should consider the role of checklists in the context of a broader initiative. Other components of the initiative might contain some of the following themes:

  • Facilitating more effective communication among patient care teams;
  • Empowering front line workers and nurses to take ownership of patient safety; and,
  • Implementing audit and feedback loops that continuously improve systems.

Although checklists are not sufficient for total patient safety, they are necessary for improving processes.

5. Checklists are free.

In this age of rising healthcare costs and limited hospital budgets, checklists are a free resource.

For example, the Physician-Patient Alliance for Health & Safety (PPAHS) offers a free checklist to prevent errors related to patient-controlled analgesia pumps. The PCA Safety Checklist is not only free to download, but it now can be “checked” as recommended steps are completed and healthcare facilities are encouraged to “adapt” it by adding, for instance, their logos to the word document. Please go to top right-hand corner of http://www.ppahs.org.

The benefits of checklists are not limited to health care settings, either. Construction and air travel are two high-skill industries that regularly make use of checklists. Other industries such as software development are using checklists as quality control tools.

As checklists continue gaining popularity outside of health care settings, health care professionals should continue to explore new opportunities to collect evidence, summarize the evidence into action-oriented checklists, develop processes for implementation and performance measurement, and communicate these processes with patients.

What other benefits do patient safety checklists provide for health care professionals? Leave your thoughts in the comments below.