Promoting a Culture of Safety

Over the past 10 years, checklists have been incorporated into the perioperative environment in increasing numbers. The concept appears to be a simple one: develop a simple list of critical items that need to be double-checked before, and in some cases after, any anesthetic or surgery. This has been extended to other phases of perioperative care such as patient handoffs to the PACU (Post-Anesthesia Care Unit) and placement of central lines, for instance. The World Health Organization's “Safe Surgery Saves Lives”1 may be the best known of these instruments. Atul Gawande2 popularized checklists in his book, A Checklist Manifesto. Gawande distinguishes between errors of ignorance (mistakes we make because we don't know enough) and errors of ineptitude (mistakes we make because we don't make proper use of what we do know). Mishaps in medicine and many other fields, he writes, are really about the second of these errors, which checklists hope to address