Making a list, saving a life

Failure to manage life-threatening complications in surgical patients is the leading cause of variation in surgical mortality in hospitals. Changes in the aviation and nuclear power industries have made the use of checklists during a crisis routine, but when a patient hemorrhages or goes into shock during an operation, a surgical team has no such checklists for guidance. A Harvard School of Public Health team created a series of checklists to improve care during common operating room crises such as anaphylaxis, air embolism, and cardiac arrest. Seventeen operating room (O.R.) teams, including nurses, anesthesiologists, surgeons, surgical technicians and residents, participated in 106 simulated surgical crisis scenarios, using the checklists. Teams were 75 % less likely to miss crucial life-saving steps when guided by checklists than when relying on memory : the rate of failure to perform certain lifesaving processes dropped from 23 % to 6 % during simulations.

The surgical team members found the checklists easy to use, and the checklists helped them feel better prepared. They include information about whom to call for additional help, causes and actions to consider, and potential diagnoses.

Nurses are often the first to consult the lists, and they also manage critical actions, such as coordinating with the blood bank, calling for a crash cart, or asking for more surgeons and nurses.

Référence : Carol Potera Arriaga AF, et al. N Engl J Med 2013;368(3): 24653.

Trouver 12 modèles de checklists à www.projectcheck.org/crisis