Surgical Checklists: A “No-Brainer”

I am handling a medical malpractice case in which the surgeon forgot to give the patient antibiotics before the operation, although all standards of care point to the need for preventative antibiotics in the type of operation done.

At the time of this incident, St. Clare’s Hospital in St. John’s did not make use of surgical checklists for breast surgery which would force the surgical healthcare team to verify that everything necessary for patient safety had been done.

Now, St. Clare’s does have a policy of using surgical checklists. Although this is too late to help my client, who developed a horrific infection, it should avoid needless complications from developing in other patients.

The outstanding question is why St. Clare’s and other hospitals have not been using such an elementary preventative measure as surgical checklists before now.

These checklists are standard practice in the aviation industry, where pilots do everything by checklists. Perhaps it has to do with the authoritarian medical culture in which physicians and surgeons in particular, do not want to concede that they may be human and are subject to human failings. Get over it! Safety challenges in our hospitals are every bit as complex as those in the aviation industry, if not more so.

I am pleased to see an article in the New England Journal of Medicine  “Simulation-Based Trial of Surgical-Crisis Checklists”, which now advocates extending the checklist method for avoiding injuries into operating room crises such as cardiac arrest and massive hemorrhage. 6% of the steps in life-saving processes of care were missed when checklists were available versus 23% when they were unavailable. Almost all of the participants in the studies said that if one of these crises occurred while they were undergoing an operation, they hoped the checklist would be used.

Hospital checklists, whether for routine procedures or for crises, avoid needless injury and death – and beat lawsuits any day.