Astronauts have checklists, why not surgeons?

The debate around checklists for physicians in general and surgeons specifically has raged for decades. When a task becomes sufficiently complex (like astronauts controlling spacecraft or pilots flying aircraft) it has been shown that simple multi-step checklists, that professionals are required to document completion of, can significantly reduce risky procedures and work. Astronauts are pretty bright, why do they need checklists but surgeons don’t?

According to the New England Journal of Medicine, a safety checklist in the operating room has the potential to reduce complications and improve survival rates of patients after surgery. Specifically, the study cited the following results:

The rate of death was 1.5% before the checklist was introduced and declined to 0.8% afterward (P=0.003). Inpatient complications occurred in 11.0% of patients at baseline and in 7.0% after introduction of the checklist (P<0.001).

If that’s not a reason to use checklists I’m not sure what else would motivate a hospital administrator to standardize on it.

Surgeons and physicians have generally opposed such checklists (and there many reasons why) but this week I ran across this iPhone app called Safe OR which is a simple surgery safety checklist. It’s a wonderful little application that could really save lives and it’s the kind of healthcare IT I love – dirt simple to get and use and it has immediate utility. If you’re a participant in any surgeries I’d recommend checking it out.

Safe OR App Screenshot

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4 thoughts on “Astronauts have checklists, why not surgeons?

  1. I could not agree more.

    As a former military (U.S. Navy) and commercial (Pan American) pilot and I live – and potentially die – by checklists. All airplanes – and other complicated machinery (e.g. nuclear submarines) – are operated by checklists. Period.

    I am going to guess that doctors, particularly surgeons, feel “above” using checklists? This may be a dying sentiment. Medical diagnosis has gone almost exclusively from “Gestalt” diagnosis to “differential” diagnosis – which is more of a decision-tree method of coming to a conclusion (something pilots and mechanics have been doing for years) and then addressing the problem based on a checklist. There are of course some gifted surgeons who make by-pass surgery look like an art but the truly gifted almost certainly have, at least, a mental checklist. Hubris is discouraged among pilots. Said another way, there are old pilots and there are bold pilots but there are no old, bold pilots. Of course pilots have a vested interest in safely handling an emergency, doctors can just bury their mistakes.

    I can absolutely assure you that the moment U.S. Air Flight 1549 lost power, her crew defaulted to a checklist. In fact, after reading an interview with Captain Sullenberger, it was apparent to me – being able to read between the lines – that he felt he had “missed” something or had failed to fully exercise the checklist. As an aside, it appears that he did not miss anything.

    There is a training-aid among pilots when dealing with an emergency, “Fly, Why, High” which means, fly the airplane first, then seek to determine the problem. The third step (“high”) is probably different depending on the situation (or aircraft type), but it means to maintain as much altitude as you possibly can with the best option being to gain altitude – not always an option.

    Flying an airplane is like having a tiger by the tail: it’s not necessarily dangerous… as long as you know what to do next. Checklist give you that option.

  2. William Thomas Bain

    Reply

    Why don’t laypeople treat themselves and do their own surgery. You like checklists? Put one in your sigmoid! The medical profession has become really not worth the trouble.

  3. This is all well and good. But I can’t say I agree with this. I work in theaters in a major UK hospital and have done for many years (not as a surgeon). And a lot of things are done before anyone even touches the patient to ensure there are minimal risks.

    And you cant compare a person to machinery. Planes are designed in a certain way for a purpose. People on the other hand are very unpredictable and are all build differently, so a checklist would not work. Please tell me what the checklist would have on it for a surgeon?

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