For far too long, hospitals have resisted the use of simple checklists designed to prevent infections and other medical errors. At last, however, the resistance is beginning to fade.
One sign of this was the recent invitation extended by the South Carolina Medical Association to William Berry, a heart surgeon at Harvard who is involved with a safe-surgery initiative sponsored by the World Health Organization. The association has asked Dr. Berry and his group to introduce surgical checklists as a standard procedure in operating rooms across South Carolina in order to reduce surgical errors.
Another key figure in the checklist effort is Dr. Peter Pronovost, an anesthesiologist at Johns Hopkins who field tested the use of checklists in Michigan in 2003. Now, Pronovost and his safety group are working with hospitals and public health administrators in over 20 states to increase the use of checklists.
Such checklists do not only remind surgeons and other medical staff to wash hands and wear sterile gloves. Those reminders are important, but the real revolution in hospital culture comes in the way checklists promote communication among all members of a medical team. In the old operating room model, the surgeon held the balance of power. Nurses and others were reluctant to speak up, even if they suspected an error.
The use of checklists gets past that communication barrier, so that a nurse can feel more able to remind a doctor to wish hands. In addition, surgical checklists introduce designated times to pause during a procedure – at the beginning, in the middle, and at the end. These built-in deliberative steps can prevent many errors, the evidence suggests.