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Insight: Check the Box... for Safety


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Clinician writes on clipboard

Insight: Check the Box... for Safety

By William Berry, MD, CRICO

Related to: Communication, Cures Act: Opening Notes, Nursing, Surgery, Teamwork Training

The heart of health care is “human beings caring for human beings.” The ability of humans to relieve suffering and heal disease is powerful and unquestioned. That same humanness makes the care that we give vulnerable to human failings. Much of the effort to improve the safety of patients receiving this care has gone to making the processes and systems surrounding that care more robust and resilient. And while there is a tremendous value in being able to provide unique and customized care to every patient, there are some facets of what we do as providers of care that are appropriately standardized. The need for standardization to reduce variability in the care that patients get has been demonstrated repeatedly as we have looked more carefully at the way that our systems perform for all of our patients.

Surgery is, by its very nature, a complex beast. Taming that complexity can lead to better care, but the challenge of how to best accomplish that is daunting. If you were to face the problem, what would you do? Probably gather the best evidence that you could from the best experts available and try to figure out what should be done, balanced by what can be done.

That is how the Surgical Safety Checklist was born. This project with the World Health Organization, lead by Dr. Atul Gawande, a surgeon at Brigham and Women’s Hospital, began in the summer of 2006. An international group of surgeons, anesthesiologists, nurses, and others met in Geneva and London in 2007. More than 100 professionals contributed during the development phase. Since late 2007, the checklist has been undergoing pilot testing around the world—from Seattle to Tanzania. Early results are encouraging; the pilot will be completed shortly and full results available later this year.

As it has evolved, the checklist has become a simple list of the most important things that every surgical patient should have…split into the three logical phases of an operation: 1) a sign-in, 2) a time out and, 3) a sign-out. It stands on the shoulders of the timeout mandated by the Joint Commission and extends it to include a pre-operative briefing and postoperative planning. If you read carefully between its lines, the checklist seeks to foster the teamwork that we all understand is so important to giving all our patients the very best care. Knowing the name of everyone in the operating room seems like a given to our patients, but it is a sad reality that anonymity rules in many American ORs. Some items on the list are already done in CRICO ORs, but in every setting—even the very best— the checklist can lead to improved performance and probably to better patient outcomes. If you haven’t seen the checklist yet or heard about it, visit [pdf].

October 1, 2008
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