Clinical review: checklists - translating evidence into practice

Abstract

Checklists are common tools used in many industries. Unfortunately, their adoption in the field of medicine has been limited to equipment operations or part of specific algorithms. Yet they have tremendous potential to improve patient outcomes by democratizing knowledge and helping ensure that all patients receive evidence-based best practices and safe high-quality care. Checklist adoption has been slowed by a variety of factors, including provider resistance, delays in knowledge dissemination and integration, limited methodology to guide development and maintenance, and lack of effective technical strategies to make them available and easy to use. In this article, we explore some of the principles and possible strategies to further develop and encourage the implementation of checklists into medical practice. We describe different types of checklists using examples and explore the benefits they offer to improve care. We suggest methods to create checklists and offer suggestions for how we might apply them, using some examples from our own experience, and finally, offer some possible directions for future research.

Figure 1

Checklist for anesthetic machines [9].

Figure 2

Elements of creating a wise checklist.

Figure 3

Landing procedure checklist for a Boeing 737-800 aircraft. Adapted from the Atlantic Sun Airways CAT B pilot procedures and checklists series [52]. KIAS, knots indicated airspeed.

Figure 4

Daily goals checklist. ABG, arterial blood gas; ABx, antibiotics; AG, aminoglycoside; Bld, blood; BMP, basic metabolic panel; bpm, beats per minute; Card, cardiology; CMP, comprehensive metabolic profile; CXR, chest x-ray; D/C, discontinue; DVT, deep venous thrombosis; EKG, electrocardiogram; eval, evaluation; FIO₂, fraction of inspired oxygen; Fluc, fluconazole; GI, gastrointestinal; gtt, drops; GU, genitourinary; Hep, heparin; HOB, head of bed; HR, heart rate; ICU, intensive care unit; ID, infectious disease; KCI SS, potassium chloride sliding scale; LMWH, low-molecular-weight heparin; LOS, length of stay; mgt, management; NDT, nasoduodenal tube; Neuro, neurology; NPO, nil per os (nothing by mouth); OOB, out of bed; OR, operating room; OT, occupational therapy; PaCO₂, arterial partial pressure of carbon dioxide; PAN Cx, pan-culture; PEEP, positive end-expiratory pressure; PEG, percutaneous endoscopic gastronomy; PO, per os (by mouth); PPI, proton pump inhibitor; Prealb, prealbumin; PS, pressure support; PSN, patient safety network; Pt, patient; PT, physical therapy; PUD, peptic ulcer disease; pulm, pulmonary; q, every; Resp, respiratory; ROM, range of motion; RR, respiratory rate; RTW, ready to wean; SCD, sequential compression device; SIRS, systemic inflammatory response syndrome; SSI, sliding scale insulin; TEDS, thromboembolic deterrent stockings; TF, tube feeding; TGC, tight glucose control; tol, tolerated; TPN, total parenteral nutrition; WBC, white blood cells.