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Checklist design and implementation: critical considerations to improve patient safety for low-frequency, high-risk patient events
  1. Carman Turkelson1,2,
  2. Megan Keiser1,3,
  3. Gary Sculli4,
  4. Diane Capoccia5
  1. 1 School of Nursing, University of Michigan Flint, Flint, Michigan, USA
  2. 2 Nursing Education & Research, Beaumont Health System, Royal Oak, Michigan, USA
  3. 3 Advance Practice Provider Services, Beaumont Health System, Royal Oak, Michigan, USA
  4. 4 VA National Center for Patient, Ann Arbor, Michigan, UK
  5. 5 Department of Nursing, Beaumont Health System, Royal Oak, Michigan, USA
  1. Correspondence to Dr. Carman Turkelson, School of Nursing, University of Michigan Flint, Flint MI 48502, USA; carmant{at}


Purpose: This pilot project describes the development and implementation of two specialised aviation-style checklist designs for a low-frequency high-risk patient population in a cardiac intensive care unit. The effect of the checklist design as well as the implementation strategies on patient outcomes and adherence to best practice guidelines were also explored. The long-term objective was to improve adherence to accepted processes of care by establishing the checklists as standard practice thereby improving patient safety and outcomes.

Methods: During this project, 10specialised crisis checklists using two specific aviation-style designs were developed. A quasiexperimental prospective pre-post repeated measure design including surveys along with repetitive simulations were used to evaluate self-confidence and self-efficacy over time as well as the perceived utility, ease of use, fit into workflow and benefits of the checklists use to patients. Performance, patient outcomes and manikin outcomes were also used to evaluate the effectiveness of the crisis checklists on provider behaviours and patient outcomes.

Results: Overall self-confidence and self-confidence related to skills and knowledge while not significant demonstrated clinically relevant improvements that were sustained over time. Perceptions of the checklists were positive with consistent utilisation sustained over time. More importantly, use of the checklists demonstrated a reduction in errors both in the simulated and clinical setting.

Conclusion: Recommendations from this study consist of key considerations for development and implementation of checklists including: utilisation of stakeholders in the development phase; implementation in real and simulated environments; and ongoing reinforcement and training to sustain use.

  • repetitive simulation
  • crisis checklists
  • intensive care unit
  • patient safety
  • low frequency high risk patient events
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  • Contributors CT is the primary author (lead for the project and for the development of this manuscript). It has not been submitted elsewhere. MK has made contributions to the overall manuscript (background, literature review, methods, results, discussion and conculsion). GS contributed to the development of the checklists, provided consultation during project implementation and contributed to the methodology section and overall editing of the manuscript. DC supported the development of the checklists and the implementation of the project and has provided clinical subject matter expertise and editing of the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Additional information is available upon request.

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