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Checklists - first the ICU, now surgery - What about you?

January 26, 2010
by Joe Bormel
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Checklists - First the ICU, now surgery - What about you?

Atul Gawande's 2007 checklist article in The New Yorker introduced a lot of people to the power of Peter Provenost's brilliant work with checklists in the ICU. A soon to be released book, The Checklist Manifesto by the same author is discussed in a 15-minute audio interview with him here . It's worth a listen; Gawande has been thinking about and studying the use (or lack of use) of checklists, now extending into the surgical suite. He also brings new insights from Boeing, Walmart, and how Katrina was managed. For those of you who may have missed it, the anti-checklist movement is out there as well.

About six months ago, I wrote a post on the role of checklist's in HCIT, titled "Better Care Through HCIT 101: Part Five - My Garage, Your Checklists & Patient Safety (Checklists are not all in your mind)" It's worth a quick read.

Although checklists are working their way into daily medical practice, with processes like medication reconciliation, we still have a long way to go with HCIT in general, and EHRs specifically. Today, how often are the three major processes guided by checklists:

1. guided information (results, history, current orders, images, etc.) review
2. guided clinical documentation
3. guided ordering

When it's fast and easy for a physician to create a review flowsheet that represents a checklist, and convert that tool (view) into clinical documentation with minimal fuss, we'll be a large step closer to achieving the 30+% improvements in safety that Gawande's team has recently brought to surgery.

What do you think?


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