Crisis Checklists in Hospital: Translating From Complicated to Complex Care Environments

Abstract

Failure to detect and treat clinical deterioration in patients, either from a medical condition or due to a complication of surgical treatment, is a common life threatening problem. Hospitals have introduced Rapid Response Systems (RRS) to manage patients with catastrophic physiological derangements. The first responders on general medical and surgical wards will nearly always be an ad hoc assembly of available providers with limited experience in managing common emergency situations. Checklists, borrowed from aviation solutions have been used effectively as a routine safety procedure. Studies describing the use of checklists beyond the highly controlled environments of the Intensive Care Unit (ICU) and the operating theatre are rare. Checklist formats similar to the operating theatre checklists, require a team of several responders already at the bedside. However, the first-responder on medicine-surgery wards is often a lone responder, most likely a registered nurse and/or a junior doctor with limited experience in managing emergencies. The successful implementation of crisis emergency checklists has the potential to improve patient care and outcomes. RRS crisis emergency checklists are likely to be effective when they are performed as a team routine in the context and readiness for change. The success of checklists will depend on careful listening to clinicians, uptake and acceptance by providers, supported by a strongly motivated and committed team ethos.