Medical Research: What is the background for this study? What are the main findings?
Dr. Dellinger: We know from previous large studies that use of checklists is associated with improvements in patient morbidity and mortality. However, recent large studies have also shown that mandating teams to use the checklist without providing the support required for adequate implementation does not result in better outcomes. This report reviews findings from studies examining checklist compliance and use. We found that when compliance with the checklist is poor it is not as effective as when the checklist is carried out as it is intended. Checklist use appears to be a marker for institutional culture of safety, and organizations with a more robust safety culture may be more likely to use the checklist in an effective manner with resulting improvements in patient safety.
Medical Research: What should clinicians and patients take away from your report?
Dr. Dellinger: We believe that the surgical safety checklist can lead to improvements in patient outcomes. However, in order to see these changes it requires more than instructing an operating team to “check the boxes;” it requires buy in from key stakeholders and commitment to safety. For teams that are looking to introduce a checklist, or to improve their use of existing checklists, engaging operating teams to more appropriately fit the checklist to their needs is an important first step. This helps teams to feel invested in the checklist, and may also make it more relevant to the needs of the group. It is not the checklist itself, but the improved teamwork and communication facilitated by the checklist that improves patient safety.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Dellinger: Future studies should continue to examine the relationship between checklist compliance and patient outcomes and link the checklist to measurements of teamwork and communication. Additionally, more work should be focused on the implementation of checklists to understand which strategies lead to success.
MedicalResearch.com Interview with: E. Patchen Dellinger, M.D., Professor of Surgery, University of Washington, Seattle, Washingto (2015). Effective Surgical Checklists Require Culture of Safety