Hospital surgical checklists have taken off since their introduction more than a decade ago. Borrowed from the aviation industry and popularized by surgeon and New Yorker writer Dr. Atul Gawande, checklists have been hailed globally as a huge leap forward for patient safety.
But now, with several countries and U.S. states moving to mandate their use, some safety pioneers say it's time to step back and check in with checklists. “It's not a magic bullet,” said Dr. Peter Pronovost, senior vice president for patient safety and quality at the Johns Hopkins University School of Medicine in Baltimore and also a pioneer in the use of clinical checklists. While checklists offer vast potential to improve outcomes, broad implementation without proper training and coordination with staff who will use them could possibly have the opposite effect, he said.
The reassessment comes in the wake of a study reported last week in the New England Journal of Medicine that found surgical safety checklists implemented in more than 100 hospitals in Ontario, Canada, failed to reduce complications or deaths. The Ontario Ministry of Health and Long-Term Care required its hospitals to incorporate safety checklists by July 2010.
Thousands of hospitals across the globe have updated their standard operating procedures to include checklists designed to help clinicians prevent surgical errors, reduce infection rates and lower readmissions. More than 30 countries have either adopted or considered requiring use of the World Health Organization's surgical safety checklist, the organization reports. In 2011, Nevada became the first U.S. state to require medical facilities to adopt patient safety checklists to improve health outcomes.
But safety advocates worry that hasty implementation through government regulation, though well-intentioned, may not generate intended results. “Regulation is too slow to keep up with the changes in evidence-based practices,” Pronovost said. “I fear that regulating (checklists) may actually anchor you into bad practices.”