Medical errors can be reduced using checklists

In a 1999 report, the Institute of Medicine estimated that as many as 98,000 annual deaths in U.S. hospitals could be attributed to medical errors. The report grabbed the attention of not only the medical profession but the mainstream media as well.

Checklists in the hospital setting

To our credit, the health care profession looked at this data and did something about it. Atul Gawande, MD, MPH, a health policy expert and associate professor of surgery at Harvard University, Boston, published an article in the New England Journal of Medicine about the use of a surgical safety checklist (2009; 360:491-9). This article reviewed a global study in eight hospitals from all over the world that compared a pre-study and post-study rate of surgical complications and mortality following the implementation of surgical safety checklists.

The study clearly demonstrated that complications and mortality could be significantly reduced using a checklist prior to making a surgical incision.

Is it time for checklists in the office?

The importance of an in-office checklist came to the attention of one of us (Dr. Baum) when I implanted a testosterone pellet in a 45-year-old male with hypongonadism who developed a post-implant hematoma. Further questioning revealed that he was on warfarin (Coumadin), which had been noted in his initial history. The patient had also been informed to discontinue the use of the anticoagulant before the procedure. However, this fact wasn't checked before the implantation.

The checklist I use was created by the doctors and the staff, is reviewed by the nurse prior to any procedure, and is signed by the doctor before the procedure. Although our sample size is small, we have not had any significant complications-ie, preventable hematomas-following testosterone implantations.

As physicians, we must be cognizant of complications both in the hospital and office setting. We should consider using checklists in our office practices for outpatient procedures. Although the risk of complications is very small, we can significantly reduce the complication rate further using such a system. It adds minimal effort on the part of our staff but provides maximum safety and security for patients and doctors.

Bottom line: Checklists are becoming part of our routine in the hospital setting and have been shown to reduce complications and mortality rates. These same checklists can be used in the office setting as well and will certainly improve the care we provide our patients.

Dr. Baum is a urologist in private practice in New Orleans. He is the author of Marketing Your Clinical Practice-Ethically, Effectively, and Economically.

Dr. Dowling is medical director of Urology Associates of North Texas, a 48-physician, community- based, single-specialty group in the Dallas-Fort Worth metroplex.