Surgical Checklists and Patient Safety: System-Level Strategies for Implementation

BACKGROUND: Surgical checklists have been demonstrated by the World Health Organization to be an effective means of reducing preventable medical error. Nevertheless, checklist use has yet to be adopted as a patient safety measure in the majority of US hospitals. OBJECTIVES: The purpose of this study is to identify system-level strategies for widespread implementation of surgical safety checklists, and to discuss methods for overall quality assessment. METHODS: Review of past and current checklist initiatives, and analysis of state and federal regulatory influence in outlining nation-wide implementation strategies. RESULTS/CONCLUSIONS: States possess the regulatory authority to enact policy-level guidelines to ensure checklist use as a surgical standard of care. State-level implementation strategies should include operative checklists that are 1) amenable to a system of accountability, 2) specialty-specific, and 3) instituted in a timely manner. Federal quality assessment should also be included to 1) better evaluate patient safety measures on a national level, 2) share good practices, and 3) to determine whether federal financial support may be needed.