Articles: checklist.
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The process of developing checklists to rate clinical performance is essential for ensuring their quality; thus, the authors applied an integrative approach for designing checklists that evaluate clinical performance. ⋯ This approach integrates published evidence and the knowledge of domain experts. A robust development process is a necessary prerequisite of valid performance checklists. Establishing a widely recognized standard for developing evaluation checklists will likely support the design of appropriate measurement tools and move the field of performance assessment in health care forward.
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The effectiveness of the World Health Organization's (WHO) surgical safety checklist (SSCL) in decreasing mortality and morbidity of surgical procedures was firstly suggested in 2009; the checklist is now strongly recommended internationally for adoption as a highly effective yet economically simple intervention. However, since 2009 several published studies have reported inconsistent results, besides many issues concerning local implementation. Drawing on the recently published experience carried out in Ontario, a concise overview of the current debate is presented, with some comments on implications for the national healthcare system in Italy. More generally, the need to include the implementation of the SSCL in a larger effort addressing safety in surgery is pointed out.
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Patients frequently do not receive recommended therapies because performance expectations are often unclear. Clinical guidelines provide exhaustive details and recommendations, but this information is not formatted in a way that supports decision making or bedside translation of therapies. When performance expectations are unclear, it is difficult for clinicians to assess their own or others' competence. ⋯ Fourth, checklists provide an opportunity to evaluate and improve an individual's performance concurrently with the context in which it is delivered. A tighter connection between education and training activities and process improvement strategies will accelerate improvements in safety and quality. Schmutz and colleagues have provided advancements in performance evaluation that will help health care achieve higher-quality and safer care.
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Am. J. Obstet. Gynecol. · Jul 2014
Maternal mortality in the United States: predictability and the impact of protocols on fatal postcesarean pulmonary embolism and hypertension-related intracranial hemorrhage.
The purpose of this study was to examine the efficacy of specific protocols that have been developed in response to a previous analysis of maternal deaths in a large hospital system. We also analyzed the theoretic impact of an ideal system of maternal triage and transport on maternal deaths and the relative performance of cause of death determination from chart review compared with a review of discharge coding data. ⋯ Disease-specific protocols are beneficial in the reduction of maternal death because of hypertensive disease and postoperative pulmonary embolism. From 2-6 women die annually in the United States because of cesarean delivery itself. A reduction in deaths from postpartum hemorrhage should be the priority for maternal death prevention efforts in coming years in the United States.
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Letter Historical Article
Standardization of surgical procedures: beyond checklists?