Impact of checklists on inpatient safety: A review of recent literature

Abstract

Background: Increase in public education and demands for patient-centred care prompt further research into transparent, organized and, above all, safe medical care. The checklist appears capable in theory to resolve some of the issues of patient safety, however its relevance and value in current practice has been questioned and adoption remains low among medical communities worldwide. Objective: to conduct a systematic review of articles of the current effect of checklists on patient safety in terms of improving patient outcomes and reducing medical errors in the inpatient setting. Methods: Search was conducted using Google Scholar with no language or study design restrictions and included keywords 'checklist', 'impact' and 'patient safety'. Publications before January 2016 were excluded to more closely reflect its impact in current medical practice. Only studies on quantitative measures of impact were included. Case reports, editorials, letters, commentaries, reviews, overviews and conference abstracts were excluded. Studies with checklists employed as part of a 'bundle', impact assessed in a simulated setting, involved outpatient setting were excluded. Titles that obviously did not match the review's aim were also excluded. Main Results: 114 articles were identified, of which 19 satisfied the eligibility criteria. Articles evaluated checklist impact in terms of patient outcomes (mortality, adverse events, length of hospital stay) and staff adherence to standard guidelines. Studies reported mixed results of checklist impact in patient related outcomes, however uniformly found statistically significant improvements in staff adherence (mean number of items completed 8.7 (SD=1.5) without checklist to 10.9 (SD=1.1) items with checklist out of 12 items, p<0.0001). Several studies also reported significant effects when completed checklists are compared with patient related outcomes (20.0% when checklist not completed vs 11.3% when checklist completed, p=0.026). Conclusion:The studies concluded a possible contribution of the checklist in patient-related outcomes, with much inconsistency in findings among different studies. The few articles reporting on staff adherence however provided significant uniform improvement following checklist implementation. There is a need for more high-quality quantitative studies to effectively conclude its impact in patient safety. As for now, the checklist remains relevant and should be applied at a broader scale, with research priority on checklist design and quality indicators to be included.