In an airplane crisis—an engine failure, a fire—pilots pull out a checklist to help with their decision-making. But in an operating room crisis—massive bleeding, a patient’s heart stops—surgical teams don’t. Given the complexity of judgment and circumstances, standard practice is for teams to use memory alone. In a new study published in the January 17 issue of the New England Journal of Medicine, however, researchers at Ariadne Labs, a joint center for health system innovation at Brigham and Women’s Hospital and Harvard School of Public Health, have found that teams using checklists have markedly better safety performance. Specifically, the research shows that clinicians provided with checklists in a novel study using advanced simulation of surgical crises were three-fourths less likely to miss key life-saving steps in care.
With many surgical procedures happening simultaneously and around the clock in a hospital setting, crises in operating rooms occur frequently; however, for individual clinicians, these incidents are rare. These high-risk, stressful events require rapid, coordinated care, and failure to rescue surgical patients who have life-threatening complications is the largest source of differences in rates of surgical death between hospitals. Researchers report that the failure rate for performing life-saving processes of care dropped from 23 percent to 6 percent during simulations when checklists were available.