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Hastings Center News

Improving Patient Safety in the Operating Room

How can health care systems increase the effectiveness of patient safety checklists? Nancy Berlinger, a Hastings Center research scholar, and Elizabeth Dietz, a project manager and research assistant, examine this question in a new article in the AMA Journal of Ethics.

The article focuses on the limitations and ethical dimensions of patient safety checklists –structured, situation-specific reminders concerning safety that aim to guide clinical personnel preparing for a surgical or medical procedure. The article uses surgical checklists as a case study.  Surgical checklists often contain a time-out – a built-in pause intended to encourage team members to speak up about safety concerns before starting a procedure. The authors discuss recent research into failures and shortcomings of checklists. Poor design or unclear relevance, for example, can prompt checklist fatigue. Or, a dismissive attitude toward the time-out on the part of a senior surgeon can powerfully convey to other team members that expressing concerns about safety will not be welcome.

Berlinger and Dietz recommend that health care systems involve the entire surgical team in the process of implementing and adapting checklists and in considering the clinical and ethical value of a time-out. “When senior surgeons are seen to be willing to spend time on the ‘how’ and ‘why’ of the time-out,” they write, “their actions can support and improve interprofessional communication and safety in the OR.”

Berlinger’s most recent book, Are Workarounds Ethical?: Managing Moral Problems in Health Care Systems, explores workarounds and other improvised practices in health care systems.