Human Factors Principles for Adapting the Checklist

HUMAN FACTORS PRINCIPLES

IN ADAPTINGTHE SURGICAL CHECKLIST

Further Considerations for the Checklist

Additions to the Checklist

In the Briefing section: Include listing of specific equipment.
In the Debriefing section: Include wound classification, tumour bank listing.

Use of the Checklist

How can we ensure that the patient is able to participate (where possible and appropriate) in (parts of) the Checklist? What if the patient needs his/her hearing aid or glasses? What about translation / interpretation services?
How do we get all team members to participate in use of the Checklist? What do we do with those who think that “Checklists are for the lame and the weak”? (Reference: Helmreich RL, Wilhelm JA, Klinect JR, Merritt AC. Culture, Error and Crew Resource Management”. Chapter 15 in Improving Teamwork in Organizations. Salas E, Bowers CA, Edens E (Eds.). Lawrence Erlbaum, Associates, Publishers, Mahwah, New Jersey, 2001.
What if there is more than one team is involved, e.g., organ donation / retrieval / transplantation? In particular, organ retrieval teams often literally ‘fly in’ and come with their own team actions, behaviours and culture.
What if a robotic procedure is to be performed and/or if video conferencing is required?
What if a patient is involved in a clinical study?

Timing of use of parts of the Checklist

When is the ‘right’ or best timefor use of the checklist in the case of an emergency procedure, e.g., patient with a ruptured aortic aneurysm?
When is the ideal time for Debriefing, especially if dealing with a hybrid team, as with multiple surgical procedures?

Checklist scorecard

If the checklist is truly about communication, then why is it called a ‘checklist scorecard’?
The scorecard portion may be a deterrent to communication, in that measurement takes precedent over communication and there are ‘administrative requests’ for ‘more measurement’.
Can or should parts of the checklist be included in the Electronic Health Record (EHR)?

Future considerations

Please provide web-based resources or references for best practices for clear labeling, e.g., for specimens.
We need to provide early introduction of the concept of the Checklist into the educational curricula of healthcare providers.
We need to incorporate the Checklist into simulation exercises / training.

Take-Home Learnings about Human Factors and the Checklist

The title of a document ‘drives’ its purpose. We need to determine what the true purpose of the document is and then name it accordingly.

If the purpose of the Checklist is to improve communication, then do not include the Checklist as part of the patient’s healthcare record.

Many are already “checking off” many of the items on the checklist. This has two implications. (1) The concept of a ‘checklist’ is already accepted and generally in use in most, if not all, operating rooms in Canada. (2) We need to ensure that there is no reduplication of activities and effort and will need to consider how to integrate current ‘checklist’ activities, as well as current measurement functions.

There is actually a need for a true ‘intraoperative care checklist’, the purpose of which is to ensure that actions vital to the safety of the patient are not forgotten. Many procedures now have specific requirements (for example, related to medication, equipment and technology). Patients should be able to have a specific intra-operative care plan for any of these procedures, in the same way that their care may be directed by pre-operative and post-operative care plans.

Do not modify the Checklist just to modify it!Before making any changes, please review the document, “Surgical Safety Checklist: A Redesign Using Human Factors Guidelines”

Feedback about the Workshop

Participants engaged in spirited discussion.

Many thoughtful ideas and details were presented and we apologise if any are not listed here.

Thank you to all!

Building a safer health system