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British Journal of General Practice
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Letters

Could checklists support teams in stressful situations?

Sarah O’Hare, Gerard Gormley and Richard Conn
British Journal of General Practice 2020; 70 (699): 486. DOI: https://doi.org/10.3399/bjgp20X712757
Sarah O’Hare
Queen’s University Belfast, Belfast. Email:
Roles: GP Academic Research Trainee
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  • For correspondence: sohare774@gmail.com
Gerard Gormley
School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast.
Roles: Clinical Professor
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Richard Conn
Queen’s University Belfast, Belfast.
Roles: Academic Clinical Lecturer
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We welcome Grieg et al’s debate article about checklists.1 Any activity that supports GPs 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 health care 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 health care 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.3

We remain convinced about the potential usefulness of checklists, particularly in pressurised, infrequently occurring situations such as emergencies. However, faced with the complex, contextualised nature of health care, we recommend qualitative, sociocultural research to develop a deeper understanding of how they can be made to work effectively and in what contexts. We also recommend road testing of checklists — a process that may be supported by the emerging field of in-situ simulation4 to ensure that they work within the realities of real-world general practice.

  • © British Journal of General Practice 2020

REFERENCES

  1. 1.↵
    1. Greig P,
    2. Maloney A,
    3. Higham H
    Emergencies in general practice: could checklists support teams in stressful situations?Br J Gen Pract2020DOI: https://doi.org/10.3399/bjgp20X709373.
  2. 2.↵
    1. Clay-Williams R,
    2. Colligan L
    Back to basics: checklists in aviation and healthcareBMJ Qual Saf2015247428431doi:10.1136/bmjqs-2015-003957
    OpenUrlFREE Full Text
  3. 3.↵
    1. Urbach DR,
    2. Govindarajan A,
    3. Saskin R,
    4. et al.
    Introduction of surgical safety checklists in Ontario, CanadaN Engl J Med20143701110291038doi:10.1056/nejmsa1308261
    OpenUrlCrossRefPubMed
  4. 4.↵
    1. Patterson MD,
    2. Geis GL,
    3. Falcone RA,
    4. et al.
    In situ simulation: detection of safety threats and teamwork training in a high risk emergency departmentBMJ Qual Saf2013226468477
    OpenUrlAbstract/FREE Full Text
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British Journal of General Practice: 70 (699)
British Journal of General Practice
Vol. 70, Issue 699
October 2020
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Could checklists support teams in stressful situations?
Sarah O’Hare, Gerard Gormley, Richard Conn
British Journal of General Practice 2020; 70 (699): 486. DOI: 10.3399/bjgp20X712757

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Could checklists support teams in stressful situations?
Sarah O’Hare, Gerard Gormley, Richard Conn
British Journal of General Practice 2020; 70 (699): 486. DOI: 10.3399/bjgp20X712757
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