Checklists, briefings and debriefings: an evidence summary

Checklists, briefings and debriefings: an evidence...
01 Jun 2015

Surgical checklists, briefings and debriefings have recently begun to be used in theatres worldwide. The aim of these tools is to improve the quality and safety of health care services provided to patients undergoing surgery and to help prevent adverse events. Checklists, briefings and debriefings have been derived from other high reliability industries, where errors are not acceptable, such as aviation and nuclear power. This document sets out to provide evidence for the use of checklists, briefings and debriefings, providing an overview of research and studies undertaken in various hospitals.

Analogies to aviation have helped clinicians understand principles of system safety and error causation. The Crew Resource Management (CRM) techniques adopted from aviation include the use of surgical safety checklists, and briefing and debriefing before and after an operating session. These are also used across other high-reliability industries including the military, nuclear power, mining and law enforcement. These techniques have been found to deliver benefits including better teamwork, better satisfaction with care, better processes and reduced error rates.

In aviation, checklists came ‘into their own’ following the crash of a new Boeing at its launch event in 1934. Although flown by an experienced pilot, the media reported it was ‘too much plane for one man to fly’. However, this was not the case; the new Boeing was ‘simply too complex for one man’s memory’. Checklists were subsequently developed for pilots and co-pilots to make sure nothing was forgotten.

During the 1960s and 70s the aviation industry grew to realise the cause of accidents had shifted from equipment failure to human error. CRM techniques were developed in this era to help teams perform at their best and recognise and correct error. This reduced incidents and accidents.4 The use of checklists has been found to contribute towards a reduction of reliance on memory, standardisation of processes, improvement of information access and provision of feedback.

NASA began looking at the role of human error in airline crashes in 1979, with a focus on safety, efficiency and the morale of people working together,6 all transferable to the operating theatre environment. The techniques are applicable to the operating theatre as, like aviation, there is increasing complexity in the delivery of surgery with even routine surgery requiring complex coordination across surgeons, anaesthetists, nurses, technicians and equipment to provide timely and effective care.

Page last modified: 15 Mar 2018