​Implementation of surgical safety checklists can lead to improved frequency of "good catches," according to a study published in the December, 2016, issue of Surgery. Good catches, like near misses, are defined as "events that have the potential to cause patient harm but are prevented from occurring due to happenstance or a timely intervention," the authors said, noting that good catches are indistinguishable from adverse events in "all but the outcome." The authors performed a prospective cohort study on checklist use for pediatric patients undergoing surgery at a tertiary children's hospital with 278 inpatient beds from 2011 and 2015. During the course of the study, adherence to the preincision checklist improved from 30% in 2011 to 95% in 2015. However, during the same period, adherence to the anesthesia preinduction checklist decreased (71% adherence to 56%) and adherence to the debriefing checklist remained the same (76%). While the authors said achieving wider adherence to checklists should be a goal, adherence did not have an effect on good catches upon regression analysis. Good catches occurred after use of the preincision checklist 16% of the time. The most common good catches (32%) related to process issues. Cardiovascular surgery and otolaryngology saw the greatest percentage of good catches attributable to checklist use. Implementation of a systematic checklist program led to a "significant and sustainable improvement in performance," the authors concluded. Good catches, they added, may be a more appropriate measure of checklist effectiveness than actual patient harm.

HRC Recommends: Checklists are not appropriate or necessary for all processes. But when developed for selected applications and designed effectively, checklists can help individuals and teams remember the steps in a process and reduce cognitive load. Organizations may wish to evaluate whether checklists currently in use are effective (e.g., by measuring how often they lead to "good catches") and whether additional processes are good candidates for checklist use. Any checklists used should be tailored to the needs of the organization and the patient population.