— Steve Rowe (@Kangaroosteve) November 28, 2013
The responses were so amazingly useful that they just had be Storified for posterity (read on).
Checklists are hot.
In fact, they’re so hot that Dr. Atul Gawande (in addition to writing extensively about this in the academic and popular press) and colleagues have dedicated an entire website to the concept. They’ve even come up with a Checklist for Checklists (also, see their checklist Implementation Guide).
I’m a big believer in standardization and in the use of checklists when stakes are high and time is short. This isn’t a universal principle, of course. Medicine is not one-size-fits-all, and checklist overuse will just result in checklist fatigue. However, in the right setting, they should be used all the time, every time.
To create a practicable checklist, consider the following:
- Design each item to address a specific, actionable, critical safety step
- Make it short and easily understandable
- Utilize natural breaks in work-flow
- Build it in to your process and delegate a team member
- Review, Revise and Refine
Rapid Sequence Intubation (RSI) is one situation in Emergency Medicine in which preparation is king and there is zero tolerance for error. In our own small slice of the living medical literature – the FOAMiverse – Dr. Scott Weingart (@EMcrit) and others have been aggressively promoting the use of RSI checklists. If you don’t buy it, listen to this talk by Dr. Minh Le Cong from SMACC 2013 about “Airway Clean Kills“. Intubation offers you many ways to kill your patient. Checklists can help avoid some of them.
The traditional print literature has yet to catch on and so there doesn’t seem to be a specific evidence base for ED RSI checklists (except this Pediatric EM abstract), but it wouldn’t be surprising if the topic starts trending soon. Some discussion already exists in the Anesthesia and Critical Care literature around intubation checklists. The Royal College of Anesthetists even describes an RSI checklist for ED’s and ICU’s in NAP4.
See below for the Storified conversation between Steve Rowe and some other very smart people. After you’ve clicked through the links and looked at all 5 checklists, be sure to review these two sites for a glut of RSI safety:
- Airway Checklist Practicalities by Dr. Yen Chow (@TBayEDguy), on PHARM
- EMcrit Podcast 92: Intubation Checklist