Development of medical checklists for improved quality of patient care

Abstract

Background: Checklists are used in both medical and non-medical industries as cognitive aids to guide users through accurate task completion. Their development requires a systematic and comprehensive approach, particularly when implemented in high intensity fields such as medicine.

Objective: A narrative review of the literature was conducted to outline the methodology to designing and implementing clear and effective medical checklists.

Methods: We systematically searched for relevant English-language medical and non-medical literature both to describe where checklists have been demonstrated to improve delivery of care and also, how to develop valid checklists.

Results: The MEDLINE search yielded 8303 citations of which 1042 abstracts were reviewed. On the basis of criteria for inclusion and subsequent full-manuscript review, 178 sources, including 17 non-medical publications, were included in the narrative review. This information was further supplemented by expert opinion in the area of checklist development and implementation. A small number of strategies for designing effective checklists were referenced in the literature, including utilization of pre-published guidelines, formation of expert panels and repeat pilot-testing of preliminary checklists.

Conclusion: Despite currently available evidence, a highly effective, standardized methodology for the development and design of medical-specific checklists has not previously been developed and validated, which has likely contributed to their inconsistent use in several key fields of medicine, despite evidence of their fundamental role in error management.