The Checklist
Odds are high that you have probably heard about surgical or operative checklists and, perhaps, some of you employ them in your clinic. This week I wanted to revisit this idea because a recent article reminded me of the benefit of checklist so I thought I'd share it with you!
How Does it Work?
You and your team devise a list of important things to remember for a given procedure and create a checklist. This list then hangs in your OR, or outside of a lab, or wherever it will be used. Ten years ago I read a book called The Checklist Manifesto (https://www.amazon.com/Checklist-Manifesto-How-Things-Right/dp/0312430000). One of the simplest ways to save a life is to know the name of your anesthetist and lead surgeon. Yep, that's it. Instead of bumbling around and saying "hey you...anesthesia..." you can address them by their name and shorten communication time in a crisis. Perhaps you work very closely with your staff everyday and it seems inconceivable that you wouldn't know someone's name! However for new staff members, or in large clinics, this may not be the case.
What is the evidence?
A study published in the Journal of Veterinary Surgery this month identified that surgical times were significantly shorter (p= .005) , antibiotic administration (when appropriate) was given as intended more often (p=.01), and fewer dogs had an unplanned return to the OR (p=.006) when a perioperative checklist was employed. (Reference below.) It takes less than 1 minute to run through the checklist and it may change the course of you or your patient's day!
What is the Take Home Message?
If you don't already have one, consider making a checklist for any procedure in which patient care could be compromised if something was forgotten. This doesn't need to apply ONLY to surgical situations! I make an effort to know the name of my assistant during each and every neurologic examination for this exact reason. I don't expect a crisis during a neurologic examination but everyone feels more committed to the team when we ARE a team! (And I like to be friendly, too!) I also had a checklist hanging in the neurology room when I was at UW and at VCA Aurora to remind trainees of the parts of the neurologic examination.
Neuro Checklist:
Mentation
Cranial nerves
Gait assessment
Postural reactions
Reflexes
Palpation
Ask about a seizure history.
Having this list in your work space ensures that you don't accidentally forget to perform part of the neurologic examination and yet, it isn't so overwhelming that you hesitate to read it. (A checklist MUST be short or people hate to do them!)
I hope you enjoyed this not-fully-totally-neurology-related TidBit Tuesday. Please let me know if you have any comments, questions, or requests for topics. Have a great week and keep those consults coming!
Reference: Thieman Mankin, KM, Jeffery ND, Kerwin SC. The impact of a surgical checklist on surgical outcomes in an academic institution. https://doi.org/10.1111/vsu.13629