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- Page navigation anchor for Emergencies in general practice: could checklists support teams in stressful situations?Emergencies in general practice: could checklists support teams in stressful situations?We welcome Grieg et al.'s debate article about checklists.1 Any activity that supports general practitioners in delivering safe, effective care in time-critical situations is greatly welcomed. However, we would like to take the opportunity to encourage practitioners to adopt a more critical approach when considering the use of checklists.As Greig et al. suggest, the rise of checklists in healthcare has largely followed their use in the aviation industry, where they provide a safety layer that protects against classic human failings like forgetting, particularly when working under pressurised conditions. But differences between healthcare and aviation present a challenge for this cognitivist way of understanding checklists.2 For example, patient complexity makes healthcare delivery much less amenable to standard operating procedures than aviation. Managing healthcare emergencies relies on seamless functioning of multiple staff members across a wide range of roles - from GPs to practice nurses to receptionists – rather than just pilots and cabin crew. Practice treatment rooms and equipment vary from place to place much more than standardised aeroplane cockpits do. This means that checklists may not always be effective, may not transfer well between contexts, or may work in different ways than expected.3We remain convinced about t...Competing Interests: None declared.
- Page navigation anchor for Properly funded services required to enact checklists in GP emergenciesProperly funded services required to enact checklists in GP emergencies
The feature “Emergencies in general practice: could checklists support teams in stressful situations?”1 argues aptly the need for concise, well-designed checklists to guide primary care teams to deliver best practice amid increasingly common emergencies. The authors briefly mention delays in emergency services in response to such emergencies, reporting that 91% of GPs audited experienced delays in ambulance arrivals,1 an issue I have witnessed first-hand.
I recall one case quite vividly as a fifth-year medical student during a primary care placement. A patient came for an emergency GP appointment, reporting intense suicidal ideations and plans to commit suicide. The patient, visibly distressed and becoming increasingly agitated in the waiting room, was moved to a side room to protect the welfare of other patients and the patient them self. Soon afterward they threatened to leave the practice and attempt suicide that same morning, at which point the decision to call an ambulance, with consent, was made, to ensure safe delivery to secondary care. We were informed the ambulance crew could not arrive for approximately 6 hours. Whilst a checklist would certainly have proven beneficial guidance for initiating escalation, a lack of one was not the rate limiting factor in this case.
The National Audit Office report between 2011 and 2016 funding for ambulance emergency services increased by 16%, yet demand increased...
Competing Interests: None declared.