Over the weekend just gone, Chris Nickson of Lifeinthefastlane threw down a challenge – the idea of a debate of ‘real anaesthetists don’t need checklists’ between Dr Minh le Cong and myself at next year’s SMACC14 conference on the Gold Coast (#SMACCGOLD).
Not withstanding the obvious inequalities between Minh’s masterful martial arts technique and my more traditional wrestling style, I reckon this will be a kick ass debate and lead nicely into some breakout discussions.
It’s no secret that I am a fan of checklists and other cognitive aids to help us in our work. I;ve been blogging about this since my post on ‘aviation & anaesthesia’ back in 2011 at the old KIDOCs blogsite (http://ki-docs.blogspot.com.au/2011/11/anaesthesia-aviation.html) and linking to usual resources see ‘Resources’ menu tab above)
Familiarity breeds contempt, and there is a benefit to introducing checklists into everyday routine BUT HIGH RISK procedures
– the WHO Surgical Checklist (more than the standard ‘surgical time out’ should incorporate checks in anaesthesia room, before knife-to-skin and before leaving the OT)
– an RSI kit dump and challenge-response checklist, as used by many retrieval services but with application to occasional intubators in the ED, ICU and rural environment
– checklists for management of crises, in OT, in ED, in Labour Ward
Not only that, use of checklists fosters teamwork, humility, discipline rather than the usual independence, self-sufficiency and autonomy that underlies most medical training.
Not convinced?
Listen to Atul Gawande talking about ‘the checklist manifesto’ (thanks to Dr Stefan Mazur of medSTAR SA for getting on board with Twitter and sharing this link)
TED talk – Atul Gawande – How do we heal medicine?
Meanwhile, bring it on…
I’d like to see that!
Pilots always use check lists and they make flying look so easy that when I sat next to them in small planes I thought why are you wasting your time…….now I am wiser!
I decided after spending a while in the ED that I would never make a good ED professional because I would be cycling home and suddenly think….bugger should have intubated that patient. If I had only used a checklist.
I think we need to be clear that checklists are NOT a substitute for clinical judgment or good training
However, they are a great way of :
– ensuring there is a shared mental model of ‘what is about to happen’ during high risk procedures (see above)
– ensuring that the essentials are not forgotten (familiarity breeding contempt and all that)
&
– standardising procedures that are not performed frequently, allowing us to ‘train hard, fight easy’
Rumour is that Minh is backing out of the debate planned for SMACC-GOLD and trying to set up Ken Milne (@thesgem) of ‘Sceptics Guide to Emergency Medicine’ blog instead. Ken’s talking at this weekend’s rural docs conference in Adelaide – from Toronto, Canada via Skype. You can catch more of him over at the podcast on ruraldoctors.net
Either way, worthy adversaries…