Željko Ferenčić MD
Željko Ferenčić MD

The human short term memory can store around seven facts at one time. The human brain may be subject to three key cognitive limitations: we may forget to retrieve one of a number of steps in a procedure; we may retrieve a step but for one reason or another (e.g. distraction, fatigue) may not remember to carry it out, or we may retrieve the step, remember to carry it out but execute the action incorrectly.

Every time we leave our cottage we agree to prepare a checklist for the next weekend, but we never do it. Last time driving to work I have entertained my wife with a story about the crash of a new Boeing’s airplane, the “299” in 1934. With the most experienced test pilot in the cockpit, the plane crashed and burst into flames. The world’s press described this event as “too much plane for one man to fly”. This led the constructors to develop and introduce four checklists to ensure that each stage was signed-off before proceeding. Later it was concluded that the “299” was not “too much plane for one man to fly”, but it was too complex for one man’s memory. The model “299” became the US Air Force’s leading plane known as the B-17 Flying Fortress with more than 12.000 of them built over time.

Back in 2009 some really spectacular results were published in the New England Journal of Medicine. These results demonstrated that using a three-part checklist during operations can cut deaths by more than 40% and complications by more than a third. The checklist later known as the WHO Surgical Safety Checklist addresses the good practice stages at three critical points:

  • Before anesthesia is administered (Sign In)
  • Immediately before the surgical incision is made (Time Out)
  • Before the patient is removed from the operating theatre (Sign Out)

Introducing such a checklist many errors have been prevented and a positive impact on patient morbidity and mortality in different surgical settings was evident.

As AACI developed and recently launched the most comprehensive endoscopy service clinical standard (AACI Standard on Endoscopy Excellence) (http://aacihealthcare.com/news/aaci-launches-worlds-most-comprehensive-endoscopy-service-clinical-standard/), I was particularly interested in an initiative published last week by Kherad et al. in Endoscopy ( Endoscopy. 2017 Dec 13. doi: 10.1055/s-0043-121218. [Epub ahead of print]). The aims of their study were to reinforce commitment in safety culture and better communication among team members in endoscopy and to prove the feasibility of successful checklist adoption before colonoscopy. They developed and introduced a simple but comprehensive checklist for endoscopy which they found feasible, but additional studies are needed to assess the generalizability of these results to complex endoscopic procedures and to characterize any improvement in patient safety outcomes.

As a surgical pathologist, I receive biopsy samples from my colleague gastroenterologists and I will for sure refer this interesting study to them and will try to convince them in implementing such a checklist in their everyday endoscopy work.

(I promise until next weekend I’ll develop a checklist for my cottage too.)