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The issue is that medicine is not air travel. For example, if an airplane doesn't pass safety checks that plane doesn't fly. What is the equivalent in the ER?

The issue is that medicine is not air travel. For example, if an airplane doesn't pass safety checks that plane doesn't fly. What is the equivalent in the ER? Furthermore, because of the way planes are engineered, (and because of the stringent safety standards), it is rarely the case that a mechanic has to make repairs on an already compromised vehicle, and even in that scenario most systems are designed to fail independently of other systems (i.e the fact that the electrical system is on the fritz doesn't change the way you inspect the propeller). In the medical realm, all of the systems interact. Reducing blood pressure may put undue stress on the kidneys, etc, so any hypothetical flow-chart is going to get really complicated really fast. The issue is partially pride, but it's also that it's not obvious that blindly adding checklists makes sense in every scenario.

rpedela 10y ago
I don't know if checklists can be used in every medical scenario, but they do have a significant positive effect in surgery [1]. 1. http://www.nytimes.com/2009/01/20/health/20surgery.html?_r=0 http://www.nytimes.com/2009/01/20/health/20surgery.html?_r=0
- nefitty 10y ago
  I think checklists can be used in literally almost any scenario. They can prevent basic errors from occurring, and can save time on unnecessary redundancy. I'm not sure what the process would be for a medical procedure but it could be 1. Admit patient 2. Consult about problem 3. Decide effective treatment 4. Perform and run through checklist of that treatment. Each step would have it's own checklist that follows the patient and that can be seen and reviewed by other caregivers. Checklists have made my life easier. For example, I got in to work today and if I hadn't made a checklist of my daily procedure I might be stuck on HN all day, but just looking over today's tasks I know what my first step and final steps look like so I can begin immediately upon entering the building. If I make a mistake I won't kill anyone, but if my life is in someone's hands I'd very much hope that they are running through a checklist built around the priority of keeping me alive first, and making me healthy second.
kevan 10y ago
If you have a chance I'd recommend reading The Checklist Manifesto [1]. There's data showing that checklists are effective in medical settings. The point of checklists is not to give you a flow-chart of exactly what to do. Their purpose is to minimize human error in routine-but-complex tasks while still allowing professionals the freedom to respond to irregular situations. Medicine, like flying a modern aircraft, has become so complex that even the best practitioners make errors in routine tasks at a surprising frequency, unless they have effective systems in place to prevent them. [1] http://atulgawande.com/book/the-checklist-manifesto/ http://atulgawande.com/book/the-checklist-manifesto/
mseebach 10y ago
> What is the equivalent in the ER? A checklist that the ER is correctly cleaned and equipped, that all equipment is in correct order and in the right place, connected, powered up and configured correctly. That all consumables are sufficient. That the correct combination of staff is present and sufficiently rested for the shift, and that lines of communication and escalation are open. A clear procedure for what happens if something isn't up to snuff, but the ER needs to operate anyway, especially making sure that everybody knows what doesn't work. Clear checklists for all standard operations. Second pair of eyes and clear unambiguous concurrency from two different qualified members of staff before any medicine is administered or other non-trivial decision is made. Etc etc etc.

rpedela 10y ago

I don't know if checklists can be used in every medical scenario, but they do have a significant positive effect in surgery [1]. 1. http://www.nytimes.com/2009/01/20/health/20surgery.html?_r=0 http://www.nytimes.com/2009/01/20/health/20surgery.html?_r=0

nefitty 10y ago
I think checklists can be used in literally almost any scenario. They can prevent basic errors from occurring, and can save time on unnecessary redundancy. I'm not sure what the process would be for a medical procedure but it could be 1. Admit patient 2. Consult about problem 3. Decide effective treatment 4. Perform and run through checklist of that treatment. Each step would have it's own checklist that follows the patient and that can be seen and reviewed by other caregivers. Checklists have made my life easier. For example, I got in to work today and if I hadn't made a checklist of my daily procedure I might be stuck on HN all day, but just looking over today's tasks I know what my first step and final steps look like so I can begin immediately upon entering the building. If I make a mistake I won't kill anyone, but if my life is in someone's hands I'd very much hope that they are running through a checklist built around the priority of keeping me alive first, and making me healthy second.

kevan 10y ago

If you have a chance I'd recommend reading The Checklist Manifesto [1]. There's data showing that checklists are effective in medical settings. The point of checklists is not to give you a flow-chart of exactly what to do. Their purpose is to minimize human error in routine-but-complex tasks while still allowing professionals the freedom to respond to irregular situations. Medicine, like flying a modern aircraft, has become so complex that even the best practitioners make errors in routine tasks at a surprising frequency, unless they have effective systems in place to prevent them. [1] http://atulgawande.com/book/the-checklist-manifesto/ http://atulgawande.com/book/the-checklist-manifesto/

mseebach 10y ago

> What is the equivalent in the ER? A checklist that the ER is correctly cleaned and equipped, that all equipment is in correct order and in the right place, connected, powered up and configured correctly. That all consumables are sufficient. That the correct combination of staff is present and sufficiently rested for the shift, and that lines of communication and escalation are open. A clear procedure for what happens if something isn't up to snuff, but the ER needs to operate anyway, especially making sure that everybody knows what doesn't work. Clear checklists for all standard operations. Second pair of eyes and clear unambiguous concurrency from two different qualified members of staff before any medicine is administered or other non-trivial decision is made. Etc etc etc.