Advancing patient safety through the use of cognitive aids

The WHO Surgical Safety Checklist (the WHO SSC)1 has had a profound impact on thinking in respect to the safety and reliability of surgery, in particular, and healthcare, more generally. It is both a cognitive aid and a tool to improve communication and teamwork. The systematic use of cognitive aids has long been embedded in many other industries, notably high-reliability industries such as aviation and the nuclear industry, but has been largely neglected in healthcare until recently. Few (if any) airplane pilots would think of taking off without making a series of important checks, and few would attempt to do this without a cognitive aid (in the form of a checklist): not only would they have an appropriate checklist available, but they would use it, every time. It is interesting that the same cannot be said with confidence of medical practitioners, including anaesthesiologists, despite the fact that anaesthesia renders patients highly vulnerable to risk and is still associated with occasional deaths or injuries, and despite mounting evidence for reduction of such events through the effective use of checklists.1–6 The latter is hardly surprising since events leading to harm during anaesthesia often result from omission of key planning steps (such as failure to anticipate and plan for a difficult airway) or other forms of basic oversight (such as failure to note an important allergy). Wetmore et al have described another strategy that seeks to change this problem.7 The Anesthesia Patient Safety Foundation (APSF) has developed a Pre-anesthetic Induction Patient Safety (PIPS) checklist from information gained through surveying over 2000 anaesthesia providers. Wetmore et al embedded the PIPS checklist into the Anesthesia Information Management System (AIMS) used in their institution in a manner that obligated users to electronically indicate compliance with the checklist in order to access the AIMS …