5 ms·

Here is a link to the actual checklist: https://apps.who.int/iris/bitstream/handle/10665/44186/9789241598590_eng_Checklist.pdf https://apps.who.int/iris/bitstr

Here is a link to the actual checklist: https://apps.who.int/iris/bitstream/handle/10665/44186/9789241598590_eng_Checklist.pdf https://apps.who.int/iris/bitstream/handle/10665/44186/97892... I'm a bit perplexed that something so simple, can reduce post surgical deaths by a third.

treis 8y ago
>I'm a bit perplexed that something so simple, can reduce post surgical deaths by a third. Because it didn't. It attributes the entirety of a decade long decline to the check list, which is obviously nonsense. I'm not saying that checklists aren't good, but they're not miracle workers.
- Camas 8y ago
  They didn't just measure the difference and call it a day. https://onlinelibrary.wiley.com/doi/full/10.1002/bjs.11151 https://onlinelibrary.wiley.com/doi/full/10.1002/bjs.11151
  - treis 8y ago
    >The Scottish Patient Safety Programme (SPSP) is a national initiative which aims to improve in‐hospital mortality rates in Scotland. The SPSP was established in 2008 and had perioperative management, including implementation of the WHO surgical checklist, as one of its four key initial workstreams. This programme offered a systematic approach to improve patient safety across all hospitals in the country26. >After testing, review and feedback from health boards across Scotland, the surgical checklist was included as one of the ten Patient Safety Essentials to be implemented across all health boards in Scotland37. The surgical checklist was not a stand‐alone intervention. It was, however, the only Patient Safety Essential that targeted surgical patients specifically during the interval studied37. Thus, the addition of the checklist to the other parameters within the SPSP may have contributed to the improvement in results observed in the present study. >It is acknowledged that attributing causal links to the findings in population‐wide data set analysis is not possible. What you said they didn't do is kind of exactly what they did. Yes, there is some attempts at hand waving, but it's silly to boil down the success of a large and multi pronged program to a simple checklist.
    - Camas 8y ago
      >It was, however, the only Patient Safety Essential that targeted surgical patients specifically during the interval studied. That's hardly hand-waving.
      - treis 8y ago
        That's exactly what hand-waving is. It's bad logic they use to support a conclusion that they then immediately hedge in the following sentence. Here's the 10 safety essentials check list they are talking about: http://www.healthcareimprovementscotland.org/news_and_events/news/news_patient_safety_top_10.aspx http://www.healthcareimprovementscotland.org/news_and_events... If the checklist is responsible for all of the improvement in surgical outcomes then we can stop doing the rest of the stuff, right? No need to emphasize hand washing or sterile central line because the magic checklist will stop the infection.
        marmshallow 8y ago
        I agree. They don't control for external variables.
        Camas 8y ago
        Even if the checklist was responsible for all of the improvement in surgical outcomes that doesn't mean the other items don't have an affect anywhere else. And again, it's not hand-waving to suggest that the item that has the largest direct impact on surgical operations is mainly responsible for the reduction. There's a difference between you wanting a more thorough study and something being "obviously nonsense".
- moate 8y ago
  https://onlinelibrary.wiley.com/doi/full/10.1002/bjs.11151 https://onlinelibrary.wiley.com/doi/full/10.1002/bjs.11151 Here's a link to the study. Please point out the parts of it that you find to be scientifically failing. There's a valid point to be made that the original article implies a greater causal link than the study, but that isn't the study's fault, and it doesn't actually diminish the effect of the checklist in the process. Poor reporting on science is always a problem, and journalists typically use layperson phrasing in order to make the information more consumable.
alexpotato 8y ago
Atul Gawande explains in great detail how simple checklists can have big impacts. For example, why would you need everyone in the room to say their name and what they do? Simple: everyone is wearing a mask and often surgical scrubs that are the same color. By having everyone say "Hello, my name is Dr. Jones and I'm the anaesthesiologist" you can quickly determine who is the person to direct questions to about the patient being under. It gets even crazier when you hear stories about doctors going into the wrong operating room (especially at bigger hospitals where there are several ORs). A simple "State who you are and why you are here?" costs very little and helps avoid costly mistakes. Another example: having a checklist allows a junior person (e.g. a nurse) to challenge more senior people when they make a mistake. Example without checklist: Nurse: Dr, I think you forgot to do X. Dr: I know what I'm doing, don't question me. Example WITH checklist: Nurse: Dr, you missed step #4. Dr: I'm sorry, you are correct. We all agreed that was a necessary step and I missed it. As have others in sibling threads, highly recommend Gawande's Checklist Manifesto.
- mnw21cam 8y ago
  A lot of airline-style cockpit resource management is being adapted for operating theatres, and it is a good thing. If a junior person thinks that a senior person is about to make a terrible mistake, then the word "Stop!" should be used, along with the reason. That word will often make even the most arrogant person pause and think about what they are doing.
- IMTDb 8y ago
  Your example depends more on the personality (and mood) of the surgeon than on the existence of a checklist. Example without checklist: Nurse: Dr, I think you forgot to do X. Dr: Oh, you are right, thanks a lot Example with checklist : Nurse: Dr, you missed step #4. Dr: I have done this list every day for the past 15 years, I know I ddid not forget anything, don't question me
  - alexpotato 8y ago
    You are correct that there are surgeons etc that would reply in the negative no matter what was said. My understanding is that if the checklist empowers, say, 5% of the nurses to speak up and 5% of surgeons to acknowledge the error that is still a huge net positive over thousands of cases. My favorite small nudge example is pill bottles vs "blister" packs. Having pills in blister packs has shown to have a significant effect on reducing suicide as it makes it much harder to get the number of pills needed. Yes, some people will still succeed but there is a segment of the target population who will give up after a couple pills.
shereadsthenews 8y ago
In any profession most practitioners are bad at what they do. There's nothing magical about medicine that exempts that profession from this rule. If your mechanic can forget to refill the oil in your engine there's no reason to believe that your surgeon won't leave a knife in your abdomen. There will be by necessity bottom-tier doctors and the checklist helps bottom-tier doctors stop killing people.
- sophacles 8y ago
  Not just bottom tier... humans are very good at making simple mistakes. It's one of the things we do best. A lot of times the people who are rated as "good" or "great" are rated that way because the make fewer mistakes, not because of perfection.
moftz 8y ago
A lot of the time, people ignore over small, simple things because they either assume someone else already took care of it or that it's such an obvious thing that how could anyone not notice. The checklist forces you to actually look up and see that the extra blood needed for the surgery didn't show up or that one of the surgeons present is actually supposed to be in another OR. It's like help desk asking you if it's plugged in. You may think of yourself as a technical person and that the problem is more complex like the driver isn't loaded or the monitor isn't properly configured but the problem could just be that you forgot to plug the video cable in. Just having those basic checks occur before anything can go wrong makes it so that when things do go wrong, time doesn't need to be wasted on going over the simple stuff or even worse, forgetting about the simple stuff and going down the wrong route.
graeme 8y ago
Humans can hold about 5-7 things in working memory. You'll note there are 22 items on that list + the headings of when to do them. Expertise and practice makes some of those things automatic, but not enough to reduce it all below 5-7. Further, in any surgery there will be other things going on that require cognitive attention, decreasing capacity for other things. Everything you can do to reduce cognitive overhead makes a process smoother. I teach the LSAT. One section logic games (officially, analytical reasoning) tests precisely this cognitive load. Students must work with 4-6 rules + what the situation calls for on question. The rules are impossibly simple. But, in the heat of things, students just aren't capable of working with that many items unless they create a structure using diagrams. And even seemingly tiny efficiencies have an outside effect on speed and correctness. Don't forget that these surgeons are often tired busy and stressed, three factors that worsen performance. Having a clear list that says "do this now dummy!" massively helps keep you on track even when you're a wreck.
macspoofing 8y ago
I'm not. A clinician is a human, and as a human, they can be distracted, tired, hungry, or any number of things that can reduce their cognition leading them to miss something. A checklist reduces cognitive overhead and provides accountability (no way a clinician would remember if they did or didn't do a particular action days or weeks or months after the fact).

treis 8y ago

>I'm a bit perplexed that something so simple, can reduce post surgical deaths by a third. Because it didn't. It attributes the entirety of a decade long decline to the check list, which is obviously nonsense. I'm not saying that checklists aren't good, but they're not miracle workers.

Camas 8y ago
They didn't just measure the difference and call it a day. https://onlinelibrary.wiley.com/doi/full/10.1002/bjs.11151 https://onlinelibrary.wiley.com/doi/full/10.1002/bjs.11151
- treis 8y ago
  >The Scottish Patient Safety Programme (SPSP) is a national initiative which aims to improve in‐hospital mortality rates in Scotland. The SPSP was established in 2008 and had perioperative management, including implementation of the WHO surgical checklist, as one of its four key initial workstreams. This programme offered a systematic approach to improve patient safety across all hospitals in the country26. >After testing, review and feedback from health boards across Scotland, the surgical checklist was included as one of the ten Patient Safety Essentials to be implemented across all health boards in Scotland37. The surgical checklist was not a stand‐alone intervention. It was, however, the only Patient Safety Essential that targeted surgical patients specifically during the interval studied37. Thus, the addition of the checklist to the other parameters within the SPSP may have contributed to the improvement in results observed in the present study. >It is acknowledged that attributing causal links to the findings in population‐wide data set analysis is not possible. What you said they didn't do is kind of exactly what they did. Yes, there is some attempts at hand waving, but it's silly to boil down the success of a large and multi pronged program to a simple checklist.
  - Camas 8y ago
    >It was, however, the only Patient Safety Essential that targeted surgical patients specifically during the interval studied. That's hardly hand-waving.
    - treis 8y ago
      That's exactly what hand-waving is. It's bad logic they use to support a conclusion that they then immediately hedge in the following sentence. Here's the 10 safety essentials check list they are talking about: http://www.healthcareimprovementscotland.org/news_and_events/news/news_patient_safety_top_10.aspx http://www.healthcareimprovementscotland.org/news_and_events... If the checklist is responsible for all of the improvement in surgical outcomes then we can stop doing the rest of the stuff, right? No need to emphasize hand washing or sterile central line because the magic checklist will stop the infection.
      - marmshallow 8y ago
        I agree. They don't control for external variables.
      - Camas 8y ago
        Even if the checklist was responsible for all of the improvement in surgical outcomes that doesn't mean the other items don't have an affect anywhere else. And again, it's not hand-waving to suggest that the item that has the largest direct impact on surgical operations is mainly responsible for the reduction. There's a difference between you wanting a more thorough study and something being "obviously nonsense".
moate 8y ago
https://onlinelibrary.wiley.com/doi/full/10.1002/bjs.11151 https://onlinelibrary.wiley.com/doi/full/10.1002/bjs.11151 Here's a link to the study. Please point out the parts of it that you find to be scientifically failing. There's a valid point to be made that the original article implies a greater causal link than the study, but that isn't the study's fault, and it doesn't actually diminish the effect of the checklist in the process. Poor reporting on science is always a problem, and journalists typically use layperson phrasing in order to make the information more consumable.

alexpotato 8y ago

Atul Gawande explains in great detail how simple checklists can have big impacts. For example, why would you need everyone in the room to say their name and what they do? Simple: everyone is wearing a mask and often surgical scrubs that are the same color. By having everyone say "Hello, my name is Dr. Jones and I'm the anaesthesiologist" you can quickly determine who is the person to direct questions to about the patient being under. It gets even crazier when you hear stories about doctors going into the wrong operating room (especially at bigger hospitals where there are several ORs). A simple "State who you are and why you are here?" costs very little and helps avoid costly mistakes. Another example: having a checklist allows a junior person (e.g. a nurse) to challenge more senior people when they make a mistake. Example without checklist: Nurse: Dr, I think you forgot to do X. Dr: I know what I'm doing, don't question me. Example WITH checklist: Nurse: Dr, you missed step #4. Dr: I'm sorry, you are correct. We all agreed that was a necessary step and I missed it. As have others in sibling threads, highly recommend Gawande's Checklist Manifesto.

mnw21cam 8y ago
A lot of airline-style cockpit resource management is being adapted for operating theatres, and it is a good thing. If a junior person thinks that a senior person is about to make a terrible mistake, then the word "Stop!" should be used, along with the reason. That word will often make even the most arrogant person pause and think about what they are doing.
IMTDb 8y ago
Your example depends more on the personality (and mood) of the surgeon than on the existence of a checklist. Example without checklist: Nurse: Dr, I think you forgot to do X. Dr: Oh, you are right, thanks a lot Example with checklist : Nurse: Dr, you missed step #4. Dr: I have done this list every day for the past 15 years, I know I ddid not forget anything, don't question me
- alexpotato 8y ago
  You are correct that there are surgeons etc that would reply in the negative no matter what was said. My understanding is that if the checklist empowers, say, 5% of the nurses to speak up and 5% of surgeons to acknowledge the error that is still a huge net positive over thousands of cases. My favorite small nudge example is pill bottles vs "blister" packs. Having pills in blister packs has shown to have a significant effect on reducing suicide as it makes it much harder to get the number of pills needed. Yes, some people will still succeed but there is a segment of the target population who will give up after a couple pills.

shereadsthenews 8y ago

In any profession most practitioners are bad at what they do. There's nothing magical about medicine that exempts that profession from this rule. If your mechanic can forget to refill the oil in your engine there's no reason to believe that your surgeon won't leave a knife in your abdomen. There will be by necessity bottom-tier doctors and the checklist helps bottom-tier doctors stop killing people.

sophacles 8y ago
Not just bottom tier... humans are very good at making simple mistakes. It's one of the things we do best. A lot of times the people who are rated as "good" or "great" are rated that way because the make fewer mistakes, not because of perfection.

moftz 8y ago

A lot of the time, people ignore over small, simple things because they either assume someone else already took care of it or that it's such an obvious thing that how could anyone not notice. The checklist forces you to actually look up and see that the extra blood needed for the surgery didn't show up or that one of the surgeons present is actually supposed to be in another OR. It's like help desk asking you if it's plugged in. You may think of yourself as a technical person and that the problem is more complex like the driver isn't loaded or the monitor isn't properly configured but the problem could just be that you forgot to plug the video cable in. Just having those basic checks occur before anything can go wrong makes it so that when things do go wrong, time doesn't need to be wasted on going over the simple stuff or even worse, forgetting about the simple stuff and going down the wrong route.

graeme 8y ago

Humans can hold about 5-7 things in working memory. You'll note there are 22 items on that list + the headings of when to do them. Expertise and practice makes some of those things automatic, but not enough to reduce it all below 5-7. Further, in any surgery there will be other things going on that require cognitive attention, decreasing capacity for other things. Everything you can do to reduce cognitive overhead makes a process smoother. I teach the LSAT. One section logic games (officially, analytical reasoning) tests precisely this cognitive load. Students must work with 4-6 rules + what the situation calls for on question. The rules are impossibly simple. But, in the heat of things, students just aren't capable of working with that many items unless they create a structure using diagrams. And even seemingly tiny efficiencies have an outside effect on speed and correctness. Don't forget that these surgeons are often tired busy and stressed, three factors that worsen performance. Having a clear list that says "do this now dummy!" massively helps keep you on track even when you're a wreck.

macspoofing 8y ago

I'm not. A clinician is a human, and as a human, they can be distracted, tired, hungry, or any number of things that can reduce their cognition leading them to miss something. A checklist reduces cognitive overhead and provides accountability (no way a clinician would remember if they did or didn't do a particular action days or weeks or months after the fact).