title: The effects of safety checklists in medicine: a systematic review.
abstract: BACKGROUND
  Safety checklists have become an established safety tool in medicine. Despite studies showing decreased mortality and complications, the effects and feasibility of checklists have been questioned. This systematic review summarises the medical literature aiming to show the effects of safety checklists with a number of outcomes.
  
  
  METHODS
  The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement was used. All studies in which safety checklists were used as an additional tool designed to assure that an operation or task was performed as planned were included.
  
  
  RESULTS
  The initial search extracted 7408 hits. Twenty-nine articles met the inclusion criteria. Five additional studies were identified by a cross-referencing search. Four groups were made according to outcome measures. One group (n = 7) had 'hard' outcome measures, such as mortality and morbidity. The remaining studies, reporting 'softer' process-related measures, were divided into three categories: adherence to guidelines (n = 6), human factors (n = 16), and reduction of adverse events (n = 5). The main findings were improved communication, reduced adverse events, better adherence to standard operating procedures, and reduced morbidity and mortality. None of the included studies reported decreased patient safety or quality after introducing safety checklists.
  
  
  CONCLUSIONS
  Safety checklists appear to be effective tools for improving patient safety in various clinical settings by strengthening compliance with guidelines, improving human factors, reducing the incidence of adverse events, and decreasing mortality and morbidity. None of the included studies reported negative effects on safety.
authors.affiliation: Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway.
authors.forename: Ø
authors.initials: Ø
authors.lastname: Thomassen
authors.forename: A
authors.initials: A
authors.lastname: Storesund
authors.forename: E
authors.initials: E
authors.lastname: Søfteland
authors.forename: G
authors.initials: G
authors.lastname: Brattebø
mesh_terms: D057189:Checklist; D017408:Guidelines as Topic; D006801:Humans; D064887:Observational Studies as Topic; D017063:Outcome Assessment, Health Care; D061214:Patient Safety / Q000706:statistics & numerical data*; D012107:Research Design