In response: simulation-based trial of surgical-crisis checklists.

Dear Sir,

Arriaga et al. describe the benefit of surgical crisis checklists for rare, life threatening events in a simulated surgical setting. The finding that those teams using the checklists had reduced levels of failure to adhere to critical management steps should come as little surprise, given the plethora of checklist-based interventions that have been described and found to be beneficial in medicine and surgery., Despite the rare occurrence of the simulated scenarios described, they have a very real impact on patient safety; contributing heavily to hospital mortality. Real life stories remind us of the value of simulating emergency scenarios where loss of situational awareness and ‘tunnel vision’ can ensue.

Given the clear benefit of using such checklists, and previous work describing the barriers to effective implementation of such a checklist, we ask what can be done now to ensure that such checklists are implemented widely and effectively? Why is WHO checklist compliance still not 100%. Monitoring such implementation may play an important role in the tailoring of checklists, to assess impact and to establish adherence. A universal and well defined education programme must parallel this implementation., Ensuring the full implementation of checklists and improving safety culture must now be the focus of research and will allow a further body of evidence to improve the quality of checklists.

Ethical approval

No ethical approval required for this study.

Conflicts of interest

No conflicts of interest have been declared by the authors.

Author contributions

AJF: Writing, critical revision, final approval.

RAA: Concept, critical revision, final approval.

Funding

No funding source declared by the authors.