Articles: checklist.
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In the context of an increasing number of publications of trial data analysed by Bayesian methods, clinicians need support to better understand Bayesian statistical methods. The existing checklists are intended for people who already know these methods. We aimed to establish and validate a checklist that contains a group of items considered crucial in interpreting the results of a phase III RCT analysed with Bayesian methods. ⋯ The checklist can help clinicians interpret the results of a phase III randomised clinical trial analysed by Bayesian methods, even clinicians with no particular knowledge of statistics, to ensure that the major elements of the statistical section are present and valid. Care should be taken in interpreting the results of a trial analysed by Bayesian methods that are not reported with these three essential items because the validity of the results cannot be established.
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Observational Study
The effects of an aviation-style computerised pre-induction anaesthesia checklist on pre-anaesthetic set-up and non-routine events.
There is ever greater interest in mitigating medical errors, particularly through cognitive aids and checklist-system long-used in the aviation industry.
Jelacic and team instituted a computerised pre-induction checklist, using an observational before-and-after study design across 1,570 cases. This is the first study of a computerised anaesthesia checklist in a real clinical environment.
They found an absolute risk reduction of almost 4% of failure-to-perform critical pre-induction steps, along with reduction in non-routine events and several examples of pre-induction mistake identification through checklist use.
Although the researchers claim the results “strongly argue for the routine use of a pre-induction anaesthesia checklist” this overstates the case a little. This study, like many similar, struggles with confounder effects on anaesthesia vigilance that may explain some of the results, particularly as arising from observational, non-randomised, non-blinded research.
Be careful
The challenge for cognitive aid research is that commonly it must use surrogate markers (workflow step failure; behavioural deviations; efficiency; time spent on task etc.) rather than the safety outcomes that actually matter to patients: death and injury.
There is no easy way around this other than large multi-center studies focusing on outcomes, such as the WHO surgical safety checklist study – which even then, has not escaped criticism!
Thinking deeper...
There will continue to be tension between those pro-checklist and those against. The irony is that both camps share a similar rationale for their position: the advocates for routine checklists point to the safety benefits of reducing cognitive load, whereas those opposing argue that enforced use is anti-individual and itself adds additional task and cognitive burden for clinicians.
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Comment Review
Theory and practical use of Bayesian methods in interpreting clinical trial data: a narrative review.
The critical reading of scientific articles is necessary for the daily practice of evidence-based medicine. Rigorous comprehension of statistical methods is essential, as reflected by the extensive use of statistics in the biomedical literature. In contrast to the customary frequentist approach, which never uses or gives the probability of a hypothesis, Bayesian theory uses probabilities for both hypotheses and data. ⋯ The aim of this review is to compare general Bayesian concepts with frequentist methods to facilitate a better understanding of Bayesian theory for readers who are not familiar with this approach. The review is intended to be used in combination with a checklist we have devised for reading reports analysed by Bayesian methods. We compare and contrast the different approaches of Bayesian vs frequentist statistical methods by considering data from a clinical trial that lends itself to this comparative approach.
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Curr Opin Anaesthesiol · Oct 2020
ReviewWrong-site nerve blocks: evidence-review and prevention strategies.
There has been increasing attention to wrong site medical procedures over the last 20 years. This review aims to provide a summary of the current understanding and recommendations for the prevention of wrong-site nerve blocks (WSNB). ⋯ Though the evidence is limited, it is recommended that a combination of multiple strategies should be employed to prevent WSNB. These include the use of preprocedural markings, well constructed checklists, time-out/stop-moments, and cognitive/physical aids. Effective implementation requires team education and engagement that empowers all team members to speak up as part of a culture of safety.
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Comparative Study Observational Study
Intelligent checklists improve checklist compliance in the intensive care unit: a prospective before-and-after mixed-method study.
We examined whether a context and process-sensitive 'intelligent' checklist increases compliance with best practice compared with a paper checklist during intensive care ward rounds. ⋯ NCT03599856.