Some thoughts on Checklists

//Some thoughts on Checklists

Some thoughts on Checklists

Rob Dixon, the Business Development Director from Pilotwise, has shared some thoughts on the use of checklists in healthcare. His thoughts have been prompted by an academic paper on the effectiveness of checklists to aid flying from the 5th International Conference on Applied Human Factors and Ergonomics, 19-23 July 2014.

Rob notes that “whilst this research example was all about flying, there is direct read-across to other areas where highly-qualified, professional humans operate in an environment of possible 3rd party death (and resultant public condemnation of their actions)”. We hope Rob’s blog article below is thought provoking, and we welcome your comments…

The paper from the 5th International Conference on Applied Human Factors and Ergonomics, 19-23 July 2014 considered that checklists (digital and paper-based) and standard procedures have been established to help pilots act in abnormal, often critical situations; these tools have to be as accurate and comprehensive as possible, but also short and easy to handle. It also considered that the procedures and checklists that are meant to support pilots in extreme situations might be inappropriate sometimes. The supporting research placed pilots in an abnormal flying situation (loss of a hydraulic system for those that understand aeroplanes) and added the time pressure of reduced fuel. The authors believed that procedures and checklists, for their abnormal situation, emerged as inappropriate. The results were usually the required task not being accomplished in time, or not even started.  Errors became apparent due to attention errors, misinterpretation or print font size, and required further research into crews’ mental models, performance and communication.

Aviation and medicine have many areas of similarity in human performance terms, one being that human must store large amounts of data for timely recall. Often the recall for decision-making is required in time critical situations, where a delay could be catastrophic. In such scenarios, checklists can aid decision-making or guard against the omission of steps in a procedure. Highly-trained humans (medical staff or aircrew) are still vulnerable to errors and/or mistakes, particularly if there is limited time in which to think and operate.

There are many areas of the medical world where standardised checklists would reduce the incident of mishap; however, checklists must be generated effectively and used correctly, so as not to increase the time in dealing with a situation, make it more confusing, stifle experience, or make staff solely reliant on their use.

Are checklists required in the medical world? If so, in which areas and who should be involved in their generation?

By | 2017-12-08T11:01:22+00:00 20th January, 2015|Editorials|1 Comment

One Comment

  1. Iain Moppett 1st February 2015 at 9:55 pm

    An interesting article. The final question is interesting. Should checklists be used in medicine? Yes – and to an extent they already are. The WHO Safe Surgery Checklist is the best known example, though doesn’t really match the urgent use checklists commonly described in aviation. The pre-use check for an anaesthetic machine is similar to a pre-flight check – though in practice this is largely done from memory. Difficult airway management is much more drill based now but still largely a memory exercise.

    We’ve just done some research work in Nottingham looking at how well current medical checklists conform to a medicalised version of the Civil Aviation Authority Checklist Assessment tool (CHAT). There are some that match up well, and quite a few that don’t. We’ll release the assessment tool for anyone to use once the paper is published (shortly!).

    There are two aspects to using a checklist though: first, the checklist itself, which is the domain of the expert content makers and format designers; second, the users. The latter group are somewhat neglected in clinical practice at the moment. For a variety of reasons folk are generally not properly trained to use them (and when not to use them).

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