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Small Things, Like Checklists, Make a Big Difference in Patient Care


Sometimes the simplest ideas are the most powerful change agents in improving the quality and consistency of medicine.

I was very excited to see Atul Gawande, MD, was going to be a keynote speaker at the American Academy of Physician Assistants annual conference in Boston this summer. As a surgical PA, I have been a great fan since he published a book called "The Checklist Manifesto: How to Get Things Right."

In his book, Dr. Gawande explores the simple idea of how checklists can prevent avoidable failures, as exampled by pilots who strictly adhere to preflight checklists for safety.

Nearly everything has happened in the air at least once before. Commercial pilots have reams of formal protocols and checklists on what to do if say, an engine shuts down, or if the flaps don’t work during takeoff and landing.

When a commercial airline pilot confronts a new problem, a procedure for dealing with the problem is rapidly developed, which is distributed to all airline pilots flying the same aircraft.

We do something similar in medicine with evidence-based best practices.

Dr. Gawande found that even in third-world countries, simple checklists could make the difference between life and death for the patient. Things like introductions of all in attendance in the operating room; verification of the patient, site, procedure, and allergies; and verification that all the equipment and biologicals needed are available.

We’re talking simple but extremely important things.

The renowned surgeon at Boston’s Brigham and Women’s Hospital and I have that appreciation in common. In my 33 years of practice as a PA, and my four years in plastic and reconstructive surgery, I have learned the importance of the simple things in making the operating room a safer place. The operating room is an inherently dangerous place with the potential for lots of small errors, which can easily and rapidly mushroom into big problems, death, and disability.

Surgery, and in most instances medicine, is a team sport. When PAs, physicians, and others work together as a team, it only enhances the safety and efficiency of the practice of medicine.

In addition to the checklists, Dr. Gawande says that all occupations have a definition of professionalism (i.e., a code of conduct) to adhere to. All professions share at least three elements:

1. An expectation of selflessness. This is inherent to the practice of medicine in that you accept responsibility for others, and place the needs of the patient above our own.
2. An expectation of skill.
3. An expectation of trustworthiness.

Dr. Gawande added a fourth element of professions in studying the utility of checklists in the practice of medicine and surgery: the expectation of discipline. This makes a lot of sense to the surgical team, and any team in the practice of medicine in following procedures and functioning as a team.

I look forward to hearing in person about Dr. Gawande’s experiences in team practice and hope to garner some pearls about enhancing the function of the team, and its potential for enhancing the safety of the operating room, and everywhere medicine is practiced.

Sometimes the simplest ideas, like checklists, are the most powerful change agents in improving the quality and consistency of medicine.

This blog was provided in partnership with the American Academy of Physician Assistants.

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