The NEJM paper published in 2009 has had an impact worldwide with the introduction of surgical checklists in over 3000 hospitals. This paper highlighted an important patient safety issue and aimed to tackle this with a relatively simple intervention. The discussion points below are meant to be a broad starting point for the evening, I hope that in particular the methodology of the paper will be discussed in detail.
1. This study ran for less than a year in eight healthcare settings and there have been many criticisms made of the methodology of the paper (see this blogpost & this letters page for examples of the criticisms). Is this adequate enough to support the widespread implementation of the checklist purely based on this paper?
2. In the discussion of the paper the authors mention the Hawthorn effect as a possible mechanism of improvement, i.e. an improvement in performance due to the subject’s knowledge of being observed. However this has also been raised as a flaw in the study, the fact that the participants knew they were in a trial could have lead to the improvements shown rather than it being due to the checklist. Does this reduce the validity of the study and its findings?
3. The checklist is a relatively simple intervention, is there a risk that this could become a tick-box exercise rather than being given due care and attention?
4. In a letter responding to the paper members of NCEPOD stated that they supported the initiative but were concerned that the implied decrease in the perioperative rate of death was unlikely to be as great in the UK as reported in the paper. Does this make the study any less relevant to practice in developed countries?
If there is time I would also like to discuss how the paper is relevant to practice in less developed countries. Thank you to @fidouglas, @amcunningham & @assidens for their help