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The 'stupid little checklist' that’s saving lives

Patient Eye

Annabel Bentley

Friday, 16 January 2009

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checklist.jpgPerhaps we’ll look back on the introduction of the surgical checklist as being as significant as the development of the advanced trauma life support (ATLS) approach for treating major trauma. Both are based on simple principles, yet have the potential to save millions of lives.

It’s tempting to think that the biggest medical breakthroughs will be from new wonder drugs or machines which go ping and magically save the day. But it seems that many more lives may be saved from something as simple as a checklist. Just tick the boxes and everything will be fine? Well it’s not quite that simple, the WHO checklist isn’t just a page of boxes to tick, it’s really about culture change and enhancing teamwork and communication.

If you need more convincing that this is a good idea then take a moment to look at the promising results of the pilot study in eight hospitals, published by the New England Journal of Medicine. This showed that after the introduction of a surgical checklist deaths fell from 1.5% to 0.8% and complications from 11% to 7%.

My only concerns are how much of the result is down to the Hawthorne effect (if you know you’re being observed in research it affects the results); and how long the effect would last once the investigators leave and the surgical teams go into business-as-usual mode.

It took 30 years for orthopaedic surgeon James Styner’s ATLS approach for trauma to be adopted in over 50 countries worldwide. So, if future studies will confirm the results of this pilot, it will be interesting to see how fast and widespread the checklist is adopted by surgical teams. Atul Gawande reflects on the success of the “stupid little checklist” in driving improvements in intensive care. But, maybe the only stupid thing about checklists will be if we don’t take them seriously.

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Annabel Bentley

Dr Annabel Bentley is interested in what evidence matters to patients and how the internet is changing healthcare. She’s debated at the Cambridge University Union debating society and is a member of the Department of Health expert working group for the information accreditation scheme. Originally trained as a plastic surgeon, she set up a patient information project and gained experience in marketing and web development. Her current role is Bupa’s assistant medical director where she is responsible for the development of health information resources for customers worldwide. See
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