• Christian P Subbe, John Kellett, Paul Barach, Catriona Chaloner, Hayley Cleaver, Tim Cooksley, Erik Korsten, Eilish Croke, Elinor Davis, Ashley Jr De Bie, Lesley Durham, Chris Hancock, Jilian Hartin, Tracy Savijn, John Welch, and Crisis Checklist Collaborative.
• Ysbyty Gwynedd & Bangor University, Penrhosgarnedd, Bangor, LL57 2PW, UK. csubbe@hotmail.com.
• Bmc Health Serv Res. 2017 May 8; 17 (1): 334.

Background'Failure to rescue' of hospitalized patients with deteriorating physiology on general wards is caused by a complex array of organisational, technical and cultural failures including a lack of standardized team and individual expected responses and actions. The aim of this study using a learning collaborative method was to develop consensus recomendations on the utility and effectiveness of checklists as training and operational tools to assist in improving the skills of general ward staff on the effective rescue of patients with abnormal physiology.MethodsA scoping study of the literature was followed by a multi-institutional and multi-disciplinary international learning collaborative. We sought to achieve a consensus on procedures and clinical simulation technology to determine the requirements, develop and test a safe using a checklist template that is rapidly accessible to assist in emergency management of common events for general ward use.ResultsSafety considerations about deteriorating patients were agreed upon and summarized. A consensus was achieved among an international group of experts on currently available checklist formats performing poorly in simulation testing as first responders in general ward clinical crises. The Crisis Checklist Collaborative ratified a consensus template for a general ward checklist that provides a list of issues for first responders to address (i.e. 'Check In'), a list of prompts regarding common omissions (i.e. 'Stop & Think'), and, a list of items required for the safe "handover" of patients that remain on the general ward (i.e. 'Check Out'). Simulation usability assessment of the template demonstrated feasibility for clinical management of deteriorating patients.ConclusionsEmergency checklists custom-designed for general ward patients have the potential to guide the treatment speed and reliability of responses for emergency management of patients with abnormal physiology while minimizing the risk of adverse events. Interventional trials are needed.

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