Errors and Omissions in Anesthesia: A Pilot Study Using a Pilot???s Checklist

Abstract

There are recent concerns that anesthesiologists are becoming less skilled in providing general anesthesia for Cesarean delivery. We considered whether a verbal checklist would help in the preparation for this event. We created a list of items to be checked when preparing to administer general anesthesia for a Cesarean delivery using expert opinion. This list was loaded onto an electronic checklist system with voice prompts and tested on 20 anesthesiologists using a high-fidelity anesthesia simulator. Participants omitted to check a median of 13 (range, 7-23) of 40 items. Common omissions included not checking that the difficult intubation trolley was available and not optimizing the patient's head position. Most (95%) participants felt that the checklist was useful and 80% would like to use it for practicing simulated scenarios; 60% preferred a written checklist and 40% preferred the verbal checklist. Important checks may be forgotten when preparing to give a general anesthetic for Cesarean delivery, and the use of a checklist could improve patient safety.

Requirements for the design and implementation of checklists for surgical processes

“…Another study conducted by Hart and Owen [27] in the anesthesia field demonstrated the function of a checklist as a memory aid tool. This study investigated the possibility of using a verbal checklist to assist the anesthesiologist administering general anesthesia during cesarean delivery.…”

“…The problem with electronic checklists lies with the technology used to build the interface device. In the study by Hart and Owen [27], several subjects had difficulty understanding the voice synthesized by the device, so the written checklist was preferred to the verbal checklist.…”

How to develop an effective obstetric checklist

“…1,2,[9][10][11][12][13][14][15][16] General acceptance of the need for checklist-guided care in obstetrics has been slower, and largely limited to the past few years. Most efforts have been modeled after the groundbreaking programs developed by the Hospital Corporation of America to standardize the monitoring and administration of oxytocin, misoprostol, and magnesium sulfate, and the documentation of the management of shoulder dystocia.…”

Review article: Simulation in anesthesia: state of the science and looking forward

“…The results of these studies showed that participants were generally very positive about their training, and they perceived their training as contributing to safe practice. [38][39][40][41][42][43][44] However, a few studies also showed that this form of education was intimidating and stressful for participants, 41 and only a minority (*30%) believed it had influenced their clinical practice. 45,46 Interestingly, there is also a growing body of evidence showing that self-reports of participants do not predict their actual levels of performance.…”