Recent demonstrations of the impact of checklists in perioperative crisis management have accelerated interest in making these aids broadly available. Anyone who has managed a malignant hyperthermia crisis or anaphylactic reaction knows that there are opportunities for every member of the perioperative team to contribute to a successful outcome.
With this in mind, the Council on Surgical and Perioperative Safety (CSPS) has partnered with Ariadne Labs at the Harvard School of Public Health to launch a coordinated campaign to stimulate the availability of crisis checklists. The CSPS is a unique collaborative of the seven major perioperative professional organizations (see box). The organizations’ combined membership exceeds 250,000 and the total number of individuals in the seven professions is more than 2 million. The Council provides an ideal platform to deliver a consistent and unified message about the value of checklists and the strategies for introducing them into practice.
Council on Surgical and Perioperative Safety (CSPS) is a unique collaborative of these seven major perioperative professional organizations:
American Association of Nurse Anesthetists
American Association of Surgical Physician Assistants
American College of Surgeons
Association of periOperative Registered Nurses
American Society of Anesthesiologists
American Society of PeriAnesthesia Nurses
Association of Surgical Technologists
One compelling observation from the simulation trials of crisis checklists is that the clinicians experiencing their use took away a strong desire to have them available in their clinical practice. This provides an opportunity to leverage the appeal of these checklists through exposure in a campaign across the seven organizations. Experience is being acquired through implementation projects at several centers, including Brigham & Women’s Hospital, Stanford and Cooper Health. Early lessons about successful implementation suggest that several elements are critical: a local champion teamed with a multidisciplinary implementation team, dedicated to promoting checklist adoption; meticulous review and editing of checklist content to align with local resources and conditions; and identification of clinical locations for deployment. Multidisciplinary staff experience in using the checklists is valuable and is optimally achieved in a simulation environment, but local ingenuity in achieving familiarity with checklist use is encouraged with or without the availability of simulation facilities.
Web resources for the implementation team are available at www.projectcheck.org and at http://emergencymanual.stanford.edu.
The Council’s goal is to expose all members of the perioperative team to the crisis checklist concept through a national strategy of education and advocacy. The coordinated messaging from seven national associations should provide a headstart for local champions in bringing perioperative colleagues along in checklist adoption. We will be reminding each professional group that this exercise represents an opportunity for health care to catch up with other industries, such as aviation and nuclear power, which have put crisis checklists to the test for decades. Look for updates on crisis checklist implementation in CSPS member newsletters, conferences, websites and member emails. Successfully improving management of critical perioperative events will require cross-pollination with strategies and experience. We are poised to create the framework for this multidisciplinary, multi-institutional collaboration.
Alexander A. Hannenberg, M.D. is Associate Chair, Department of Anesthesiology, Newton WellesleyHospital, Newton, Massachusetts.
Brian J. Cammarata, M.D. is Partner and Director of Risk Management, Old Pueblo Anesthesia; Chief Medical Information Officer, Tucson Medical Center; Clinical Assistant Professor, Department of Anesthesiology, University of Arizona, Tucson.