Checklist for percutaneous tracheostomy in critical care

Simon and colleagues are to be commended for their effort in reviewing articles published since 1985 on the incidence and risk factors associated with mortality following percutaneous dilatational tracheostomy (PDT) [1]. An important milestone in an attempt to reduce surgery-related complications was the introduction of the World Health Organization Surgical Safety Checklist in 2008. A pilot study showed a reduction in both mortality and potential complications following introduction of the checklist [2]. Over 300 organisations have endorsed the campaign worldwide and 1,790 hospitals are actively using the checklist with more than 4,100 hospitals registered [3]. With such broad recognition of the importance for safety and implementation of the checklist in general surgery, it seems appropriate to follow a similar checklist for the PDT procedure in intensive care. Checklists are not alien to ICUs. Checklists have helped nursing staff to adhere to infection control guidelines and hence a reduction in bloodstream-related infections [4]. Several other checklists (mechanical ventilation, daily goals [5]) have proven useful. The checklist before PDT (see Table 1) is intended to reduce error and harm. Although the clinician has overall responsibility for ensuring that it is safe to undergo PDT, having a checklist would also provide an opportunity for the nurses to highlight or challenge any criteria that are not followed. We believe that if the checklist is tailor-made to suit individual organisations, it does not overstrain clinicians and may actually improve safety and efficiency.