The checklists in this book are intended to assist caregivers in the treatment of high acuity, low frequency events that are complicated and difficult to manage. These checklists are designed to be used, stepwise, in real time during an event. If manpower permits, a dedicated "Checklist Reader" is suggested to assist the event leader by reading the leader the items in the checklist as the team progresses through the checklist. This allows the event leader to concentrate on the overall management of the patient. However if manpower is insufficient, the team leader can read the checklist simultaneously while directing patient care. Other possible uses of these checklists include "prestudy”, either for general familiarization or immediately before a specific case in which an event seems likely (for example, studying a hemorrhage checklist before an AAA) and " postevent", perhaps as a guide to a debriefing.
As the "checklist movement" has progressed evidence has accumulated that checklist type documents improve the ability of caregivers to complete more of the crucial steps necessary to care for patients in critical situations. All of us, no matter how skilled, suffer from decreased performance under extreme stress. There is reasonable evidence to suggest that structured cognitive aids, such as an aviation style checklist, may help with this. Whether checklist use translates into improved patient outcomes is unknown, and likely depends on other factors, such as appropriate training and checklist design. However, the content of the checklists was determined by expert consensus and linking checklist use with the potential for improved patient outcomes seems logical.
However, the mere presence of the checklist doesn't guarantee its use. As this project goes forward we intend to integrate checklist use into our simulation and QA reporting, in an effort to get people to " think checklist", sooner rather than later. An hour or two of self- study could pay big dividends, for patients and caregivers, at another time. Eventually we hope to have formal training.
The checklists in this document have been modified from the Harvard checklists and also the Stanford Anesthesia Department crisis checklists. Additionally we have written several checklists of our own and adapted a number of checklists for pediatric use -- these are in the rear of the book. All of the checklists have been reformatted and adapted for use at MMC. Members of Anesthesia Dept Quality Improvement Committee reviewed the entire document for correctness, completeness and usability.
This is intended to be a "living" document; it will be reviewed yearly for additions and corrections. Please feel free to contact us with suggestions or concerns.
Finally, nothing in this book is intended to limit your ability to care for your specific patient; unforeseen circumstances will cause you to do what you think is best as a medical professional.
- Xan Abess MD
- Craig Curry MD
- Randy Darby MD
- Jim Gagnon MD
- Dan Kovarik MD
- Monica Langer MD
- Laurie Sutherland MD
- Ashley Quinn, Spectrum Medical Group
- The members of the MMC Anesthesia Dept. Quality Improvement Committee
- Arriaga, Alexander F., M.D., M.P.H., Sc.D., Angela M. Bader, M.D., M.P.H., Judith M. Wong, Judith M. Wong, M.D., M.P.H., Stuart R. Lipsitz, Sc.D., William R. Berry, M.D., M.P.H., M.P.A., John E. Ziewacz, M.D., M.P.H., David L. Hepner, M.D., Daniel J. Boorman, B.S., Charles N. Pozner, M.D., Douglas S. Smink, M.D., M.P.H., and Atul A. Gawande, M.D., M.P.H. "Simulation-Based Trial of Surgical-Crisis Checklists." New England Journal of Medicine 368.3 (2013): 246-53. Web.
- Goldhaber-Fiebert, Sara N., M.D., and Steven K. Howard, M.D. "Implementing Emergency Manuals: Can Cognitive Aids Help Translate Best Practices for Patient Care During Acute Events?" Anesthesia and Analgesia 117.5 (2013): 1149-161. Web.
- Marshall, Stuart. "The Use of Cognitive Aids During Emergencies in Anesthesia: A Review of the Literature." Anesthesia and Analgesia 117.5 (2013): 1162-171. Web.
- Mulroy, Michael F., M.D. "Emergency Manuals: The Time Has Come." APSF Newsletter 28.1 (2013): 1, 9-10. Web.
These checklists are intended to assist direct caregivers in fulfilling critical steps in the management of patients experiencing high acuity, low frequency events.
Consider Checklist use any time you need help with an unstable patient or call for a Code Cart.
Make certain you are using the right checklist for the clinical situation!!!!!!
If possible, a person not involved in the clinical care of the patient should read the checklist to the team leader.
The reader should take the leader through the steps sequentially.
The leader should acknowledge steps as they are completed.
They should move on to next step as necessary, or move to a different checklist as indicated.
Reading the checklist aloud will keep the entire team informed.
Familiarization with the contents of this book will help you use it when you need it!
These checklists are designed to help with task completion during stressful events and are not intended to replace good clinical judgment. Checklist use is voluntary.