Step By Step – How Checklists Can Help in the OR

February 4, 2010 at 3:08 pm Leave a comment

Dr. Atul Gawande is a general and endocrine surgeon at Brigham & Women’s Hospital as well as the associate director for their Center for Surgery & Public Health.  He has gained prominence by writing about his experiences in the operating room as well as examining best practices for surgeons and hospitals in such publications as, The New Yorker and two books, Complications: A Surgeon’s Notes on an Imperfect Science and Better: A Surgeon’s Notes on Performance.

In his latest book, The Checklist Manifesto: How to Get Things Right, Dr. Gawande discusses the need to implement a standardized checklist routine for surgeons before they start a procedure.  By ensuring that simple steps are taken, surgeons are able to cut down on factors that may lead to complications, including infections.  He went on The Daily Show with Jon Stewart last night to discuss his new book, what he found when the checklists were implemented, and – somehow – Star Wars. The interview can be found here.

More on Dr. Gawande’s work and how to implement these checklists after the jump:

In OpNote’s endeavor to create electronic operative reporting software, we’ve realized the strength of synoptic reporting and how it enhances most processes – especially in the medical field.

A quick definition for synoptic reporting (for the sake of this discussion) would be “processes broken up and captured as individualized points of data, or steps.”  For example – many cooking instructions are Synoptic Reports (add flour, whisk in eggs, etc.), as are Google Maps driving directions and most instruction booklets.  Synoptic reporting recognizes that human language is richer and captures all the concepts, but that it is too hard (in a practical sense) for computers to utilize or capture – thus resulting in each “concept” being individually represented.

Gawande’s checklists are synoptic reports – structured data that are systematically entered and processed.  Unstructured data (free form narrative or text) lends itself to easily to assumption and omission – when steps aren’t uniquely presented then it becomes easy to forget that they are there, or to believe that it was already accomplished.  By verbalizing (or illustrating) each necessary part of an action, participants of that action have to address it and ensure that it is performed.

These checklists could be effortlessly incorporated in electronic synoptic reports.  In fact, we’ve discussed how we could easily include them in our post-operative reports in OpNote, if facilities/users desire them.

Another example of the “Checklist philosophy” at work in our product would be our defaulted reports created by the users themselves.  By following these defaulted reports (or “templates”), which are broken up into synoptic format instead of an unstructured narrative, the user gets used to also double checking that he or she is doing each necessary step in the procedure.

Gawande points out that some of the surgeons didn’t like to utilize the checklist – about 20% by his reckoning.  However, speaking with that same group of users:

Then we asked them one more question: ‘If you were having an operation, would you want the checklist?’ 93%

Some surgeons may feel like it’s redundant – or even insulting – to go through these lists.  However, these steps are being performed anyways (or at least should be).  By capturing the fact that the surgeons did them, they are ensuring that the historical record reflects that – which can be useful in any malpractice suits, pay for performance programs, or even for future medical research.


Entry filed under: Compliance, Standardization, Studies, Synoptic Reporting. Tags: , , , , , , , , , , , , , , .

iPads, PDAs and Smartphones, Oh My! EHR – Part v. Whole

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