Articles: checklist.
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Catheter-associated urinary tract infections account for 40% of all health care-associated infections. An evidence-based, nurse-driven daily checklist for initiation and continuance of urinary catheters was implemented in 5 adult intensive care units. Measures of compliance, provider satisfaction, and clinical outcomes were recorded. Compliance with the checklist was 50 to 100%: catheter-associated urinary tract infections decreased from 2.88 to 1.46 per 1000 catheter days and catheter days decreased in 2 intensive care units.
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Hospital checklists are gaining momentum, particularly since the World Health Organization's Safe Surgery Saves Lives Program published results of its study in 2009, indicating that a safety checklist significantly improved surgical outcomes in hospitals across the world. The South Carolina Hospital Association, in partnership with Dr Atul Gawande, has launched a program to implement the World Health Organization Surgical Safety Checklist in every operating room in the state over the next few years. ⋯ Drawing on research, recent initiatives, and the company's experience in high-acuity units, this article explores the implications and challenges of implementing checklists in today's hospitals. If a checklist is to succeed as a mechanism for transforming evidence-based care and safety protocols into best and actual practice, it needs to be used consistently and durably; to achieve this, hospitals need to foster a supportive environment as well as acquire a system to monitor, measure, and manage a culture that effectively embraces checklists.
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To assess what proportion of surgical malpractice claims might be prevented by the use of a surgical safety checklist. ⋯ Nearly one-third of all contributing factors in accepted surgical malpractice claims of patients that had undergone surgery might have been intercepted by using a comprehensive surgical safety checklist. A considerable amount of damage, both physical and financial, is likely to be prevented by using the SURPASS checklist.
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Diagnostic errors are a widespread problem, although the true magnitude is unknown because they cannot currently be measured validly. These errors have received relatively little attention despite alarming estimates of associated harm and death. One promising intervention to reduce preventable harm is the checklist. ⋯ To be effective, they must reduce diagnostic errors (efficacy) and be routinely used in practice (effectiveness). Such tools must intuitively support how the human brain works, and under time pressures, clinicians rarely think in conditional probabilities when making decisions. To move forward, it is necessary to accurately measure diagnostic errors (which could come from mapping out the diagnostic process as the medication process has done and measuring errors at each step) and pilot test interventions such as these checklists to determine whether they work.
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Diagnostic errors are common and can often be traced to physicians' cognitive biases and failed heuristics (mental shortcuts). A great deal is known about how these faulty thinking processes lead to error, but little is known about how to prevent them. Faulty thinking plagues other high-risk, high-reliability professions, such as airline pilots and nuclear plant operators, but these professions have reduced errors by using checklists. ⋯ The purpose of this article is to argue for the further investigation and revision of these initial attempts to apply checklists to the diagnostic process. The basic idea behind checklists is to provide an alternative to reliance on intuition and memory in clinical problem solving. This kind of solution is demanded by the complexity of diagnostic reasoning, which often involves sense-making under conditions of great uncertainty and limited time.