Comments on: The Checklist Manifesto http://www.medrants.com/archives/5218 Internal medicine, American health care, and especially medical education Sat, 11 Feb 2012 15:15:48 +0000 hourly 1 http://wordpress.org/?v=3.3.1 By: Bruce R. Couillard http://www.medrants.com/archives/5218/comment-page-1#comment-544044 Bruce R. Couillard Thu, 24 Mar 2011 23:36:08 +0000 http://www.medrants.com/?p=5218#comment-544044 I read the book.  Beautiful!! Our early list for airplanes was "GUMP" for landing an acronym for sequential operatiions.  I  expected the author to use acronyms of sorts for trouble-shooting "trama" in the ER or for the EMS that arrived with what may have been done. The activities should use memory joggers that are easily followed.  Check-lists are substitutes for experiance, complacency,and sinility.  I read the book.  Beautiful!! Our early list for airplanes was "GUMP" for landing an acronym for sequential operatiions.  I  expected the author to use acronyms of sorts for trouble-shooting "trama" in the ER or for the EMS that arrived with what may have been done. The activities should use memory joggers that are easily followed.  Check-lists are substitutes for experiance, complacency,and sinility. 

]]> By: Donald Phillips http://www.medrants.com/archives/5218/comment-page-1#comment-531638 Donald Phillips Sun, 14 Feb 2010 13:46:26 +0000 http://www.medrants.com/?p=5218#comment-531638 One simplistic and undeniable truth about absolute need in one specific checklist area is the need to follow service procedures that protect a patient from hospital introduced infections. Every medical service should have the logistics in place and every health professional should be mandated to give and receive the simple, lifesaving reminders to protect patients - physicians' egos notwithstanding. One simplistic and undeniable truth about absolute need in one specific checklist area is the need to follow service procedures that protect a patient from hospital introduced infections. Every medical service should have the logistics in place and every health professional should be mandated to give and receive the simple, lifesaving reminders to protect patients – physicians’ egos notwithstanding.

]]> By: rtb http://www.medrants.com/archives/5218/comment-page-1#comment-531193 rtb Mon, 25 Jan 2010 06:31:13 +0000 http://www.medrants.com/?p=5218#comment-531193 Our EMR copies over the Assessment/Plan section of the most recent progress note into the current one.  For the past few years, I have ended every note with the problem heading, "Hospital Care".  The sub-headings of this checklist include items 1, 2, 3, and 5 on your checklist and also: code status, DVT prophylaxis, family contact information, and PCP contact information.  (I don't include "discharge planning" because it's a given in our organization - we discuss each patient our case managers at least 2 times a day, often more than that.) Our EMR copies over the Assessment/Plan section of the most recent progress note into the current one.  For the past few years, I have ended every note with the problem heading, "Hospital Care".  The sub-headings of this checklist include items 1, 2, 3, and 5 on your checklist and also: code status, DVT prophylaxis, family contact information, and PCP contact information.  (I don't include "discharge planning" because it's a given in our organization – we discuss each patient our case managers at least 2 times a day, often more than that.)

]]> By: r fedor http://www.medrants.com/archives/5218/comment-page-1#comment-531189 r fedor Sun, 24 Jan 2010 21:37:28 +0000 http://www.medrants.com/?p=5218#comment-531189 I agree with the premise that checklists are useful, important and necessary. I designed an encounter  form that I use that is essentially a checklist that covers most of what I need to do at each patient encounter. It helps me every day. Residents when they work in my office are required to use my encounter form. Many like it but some also use extensive notes to organize their thinking and planning. I agree with the premise that checklists are useful, important and necessary. I designed an encounter  form that I use that is essentially a checklist that covers most of what I need to do at each patient encounter. It helps me every day. Residents when they work in my office are required to use my encounter form. Many like it but some also use extensive notes to organize their thinking and planning.

]]> By: jb http://www.medrants.com/archives/5218/comment-page-1#comment-531183 jb Sun, 24 Jan 2010 15:31:33 +0000 http://www.medrants.com/?p=5218#comment-531183 Absolutely nothing wrong with checklists- you have yours, I have mine, I use them in teaching my students and residents.  These are checklists that I (and you, I'm confident), have developed on an ad hoc basis in dealing with common situations in our practice. It may be a formal written checklist, a mnemonic, a song that you sing to yourself, or anything else that works for you.  The problem comes when checklists are imposed from above as someone else's idea of how you and I should manage our patients.   The checklist then becomes an end and not a means of getting to the end, which is good care, however you and I define it.  Good care now is defined by how fast the antibiotic is given, not whether it's the right antibiotic, or if the physician has done a good job determining if it's needed at all (if an ER patient is given an antibiotic within the approved time frame, but it later is proven that it was not necessary, is there a decrease in the quality indicator for the hospital's score?).  In the OR, it's the "Timeout."  Declaring that the timeout is being done, and, more importantly, having the RN and anesthesiologist document that the Timeout was done, and documenting that the timeout was done at the same minute, takes priority over actually accomplishing what the time out is intended to do.  You will likely find that difficult to believe, but not after you ask a surgical colleague.  We should encourage checklists when they are useful, from a bottom-up perspective.  Students and trainees should be taught to be methodical, to take a minute or more and review the situation and ensure that every aspect of care is covered.  Not everything that can be counted, counts, and not everything that counts can be counted.  Every day a rent-seeking administrator tries to come up with something that we do that they can count, so they have more to do.  This has nothing to do with the practice of medicine. Absolutely nothing wrong with checklists- you have yours, I have mine, I use them in teaching my students and residents.  These are checklists that I (and you, I'm confident), have developed on an ad hoc basis in dealing with common situations in our practice. It may be a formal written checklist, a mnemonic, a song that you sing to yourself, or anything else that works for you.  The problem comes when checklists are imposed from above as someone else's idea of how you and I should manage our patients.   The checklist then becomes an end and not a means of getting to the end, which is good care, however you and I define it.  Good care now is defined by how fast the antibiotic is given, not whether it's the right antibiotic, or if the physician has done a good job determining if it's needed at all (if an ER patient is given an antibiotic within the approved time frame, but it later is proven that it was not necessary, is there a decrease in the quality indicator for the hospital's score?). 
In the OR, it's the "Timeout."  Declaring that the timeout is being done, and, more importantly, having the RN and anesthesiologist document that the Timeout was done, and documenting that the timeout was done at the same minute, takes priority over actually accomplishing what the time out is intended to do.  You will likely find that difficult to believe, but not after you ask a surgical colleague.  We should encourage checklists when they are useful, from a bottom-up perspective.  Students and trainees should be taught to be methodical, to take a minute or more and review the situation and ensure that every aspect of care is covered.  Not everything that can be counted, counts, and not everything that counts can be counted.  Every day a rent-seeking administrator tries to come up with something that we do that they can count, so they have more to do.  This has nothing to do with the practice of medicine.

]]> By: Jared http://www.medrants.com/archives/5218/comment-page-1#comment-531166 Jared Sat, 23 Jan 2010 21:00:16 +0000 http://www.medrants.com/?p=5218#comment-531166 I agree that checklists are often helpful for things a friend calls "ash and trash".  I.e. there are things that every physician should know, do, and remember, and there are others that, while important, are better left to allowing a different tool to assist you in remembering. Checklists are not a one-size-fits-all solution.  But, they can help. I agree that checklists are often helpful for things a friend calls "ash and trash".  I.e. there are things that every physician should know, do, and remember, and there are others that, while important, are better left to allowing a different tool to assist you in remembering.

Checklists are not a one-size-fits-all solution.  But, they can help.

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