This paper is not in print yet but was presented at the annual meeting of the American Association for the Surgery of Trauma (which is the parent body for the Journal of Trauma) in Chicago in September. Most would be familiar with the work of Atul Gawande and his various publications (e.g. Better, Complications, The Checklist Manifesto) and have heard of the Surgical Safety Checklist which is used the perioperative environment. But do we need a checklist even in relation to our communication with patients and their relatives?
At first glance this seems ridiculous but as has often been stated who hasn’t been sent to the supermarket by their partner for three or four items without a checklist and come home without at least one? In this research from Georgia, a study and a control group were used. In the study group residents gave information to relatives based on a checklist. This reminded them to include, amongst other things, an introduction, a list of injuries, who the patient was under, what operations were planned and whether the relatives had any questions. Control relatives were given information in a manner that was usual or the unit but without any checklist.
48 hours later the relatives were given a survey to determine the trauma team’s communication. There were 130 respondents in each group and the checklist group were better informed in relation to 8 of the 11 items in the survey including knowing who was looking after the patient, an understanding of the injuries, the upcoming investigations and the overall treatment plan.
This study challenges not only our communication processes but all aspects of our care of trauma patients. One needs to ask the question sometimes, if you were not there, how would you brief a competent healthcare provider but one who didn’t usually work in your unit to do what you do? The answer to that question would usually form the basis for a checklist. Given safe hours and the increasingly shift based delivery of care to inpatients in large hospitals the use of checklists has significant merit and this and other studies will probably continue to demonstrate more consistent and error free healthcare delivery until their use becomes ubiquitous. Using a checklist to improve family communication in trauma care.
Dennis BM, Sykes LN, Vogel RL et al. AAST abstracts, Chicago 2011.