Just the other day on out blog we featured the American Medical Association’s response to criticism that the association did little to reduce the number of preventable errors in a medical setting. Today, we’re hearing about a medical resident who has developed a checklist that appears to reduce errors and improve communication when handing a patient from one doctor to another.
Medical errors happen for all sorts of reasons, but some preventable errors occur because of a lack of communication between doctors tasked with caring for the patient from shift to shift. Other times the busy nature of their work doesn’t allow them to go over all the new patients that arrived since their last shift. To combat this breakdown in shift-to-shift communication, a fourth-year resident at Baylor College of Medicine added a new twist to an old procedure.
Residents at Baylor practice the PACT method at the end of each shift, which stands for priority, admissions, changes, and task review. This means doctors should first discuss the patients who need the most care, then go over any new admissions, then discuss the patients who have improved/worsened, and finally they should review any tasks that need to be completed during the next shift. After PACT was initially implemented at Baylor, residents completed more tasks, knew more about patients on their rounds, the discrepancy between junior and senior handoffs diminished, and senior residents had more confidence in junior residents. To build on the PACT procedure, resident Nicole Tapia wanted to see if adding a quick checklist could further reduce medical errors.
“This is something that can be used broadly to improve communication,” said Tapia.
The four item checklist asked physicians to do the following prior to completing the pact procedure: Designate a leader, premark their handoff list, move to a quiet place and to silence all mobile devices. Tapia then had some residents adopt the checklist system, while others continued to practice the PACT method on its own. When comparing the data of 71 PACT and checklist handoffs to 75 PACT alone handoffs, Tapia found on average:
- Handoffs using the checklist were conducted seven minutes faster.
- The checklist group did not have any shift errors, while there were 0.03 errors per shift in the PACT alone group.
- The checklist group reported two PACT interruptions, while the PACT alone group reported four.
- Despite some improvements, the checklist did not appear to increase junior resident patient knowledge. There was no significant increase in the junior residents’ ability to answer nurse and senior staff questions about patients during rounds after using the checklist method.
- Residents noted that high priority patients received more attention using the checklist method but said they preferred discussing patients in order of their location in the hospital.
Dr. Silverman comments
While it appears the checklist isn’t a perfect science, it’s clear that it reduced handoff errors. I’d like to see similar studies that alter or improve on the method, but I commend Dr. Tapia for her interest in reducing medical errors. It’s something we all strive to do, and every little bit helps.
As I mentioned during a previous post on surgical never-events, surgeons go through a similar checklist to ensure each move we make is the right one. This includes double and triple checking before anesthesia, before incision, and before closing the wound. Simply put, checklists and checking your work helps prevent medical errors.
Related source: Medscape
