title: Checklist usage decreases critical task omissions when training residents to separate from simulated cardiopulmonary bypass.
abstract: OBJECTIVE
  Separation from cardiopulmonary bypass (CPB) requires multiple preparatory steps, during which mistakes, omissions, and human errors may occur. Checklists have been used extensively in aviation to improve performance of complex, multistep tasks. The aim of this study was to (1) develop a checklist using a modified Delphi process to identify essential steps necessary to prepare for separation from CPB, and (2) compare the frequency of completed items with and without the use of a checklist in simulation. It was hypothesized that the use of a checklist would reduce the number of omissions.
  
  
  METHODS
  High-fidelity simulation study.
  
  
  METHODS
  University-affiliated tertiary care facility.
  
  
  METHODS
  Seven cardiac anesthesiologists created a checklist using a modified Delphi process. Ten residents participated in 4 scenarios separating from CPB in simulation.
  
  
  METHODS
  Each scenario was performed first without a checklist and then again with a checklist. An observer graded participants' performance.
  
  
  RESULTS
  A pre-separation checklist containing 9 tasks was created using the Delphi process. Without using this checklist, 4 tasks were completed in at least 75% of scenarios, and 8 tasks were completed at least 75% of the time when using the checklist. There was a significant improvement in completion of 5 of the 9 items (p< 0.01).
  
  
  CONCLUSIONS
  A modified Delphi process can be used to create a checklist of steps in preparing to separate from CPB. Using this checklist during simulation resulted in increased frequency of completing designated tasks in comparison to relying on memory alone. Checklists may reduce omission errors during complex periods of anesthesiologists' perioperative workflow.
authors.affiliation: Department of Anesthesiology, Scott & White Memorial Hospital, The Texas A&M University Health Sciences Center College of Medicine, Temple, TX.
authors.forename: Edward W
authors.initials: EW
authors.lastname: Petrik
authors.affiliation: Department of Anesthesiology, Texas Tech University Health Science Center, Lubbock, TX.
authors.forename: Dennis
authors.initials: D
authors.lastname: Ho
authors.affiliation: St. Jude Children's Hospital and Baptist Memorial Hospital, Memphis, TN.
authors.forename: Maqsood
authors.initials: M
authors.lastname: Elahi
authors.affiliation: Division of Cardiothoracic Anesthesiology, Scott & White Memorial Hospital, The Texas A&M University Health Sciences Center College of Medicine, Temple, TX.
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Ball
authors.affiliation: Department of Anesthesiology, Scott & White Memorial Hospital, The Texas A&M University Health Sciences Center College of Medicine, Temple, TX.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Hofkamp
authors.affiliation: Departments of Obstetrics & Gynecology and Internal Medicine, Academic Operations, Scott & White Healthcare, The Texas A&M University Health Sciences Center College of Medicine, Temple, TX.
authors.forename: Hania
authors.initials: H
authors.lastname: Wehbe-Janek
authors.affiliation: Division of Cardiothoracic Anesthesiology, Scott & White Memorial Hospital, The Texas A&M University Health Sciences Center College of Medicine, Temple, TX.
authors.forename: William C
authors.initials: WC
authors.lastname: Culp
authors.affiliation: Division of Cardiothoracic Anesthesiology, Scott & White Memorial Hospital, The Texas A&M University Health Sciences Center College of Medicine, Temple, TX. Electronic address: fvillamaria@sw.org.
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Villamaria
mesh_terms: D000328:Adult; D000776:Anesthesiology / Q000193:education* / Q000592:standards; D002315:Cardiopulmonary Bypass / Q000379:methods* / Q000592:standards; D057189:Checklist / Q000379:methods* / Q000706:statistics & numerical data; D002983:Clinical Competence / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007396:Internship and Residency / Q000592:standards* / Q000706:statistics & numerical data; D008297:Male; D019300:Medical Errors / Q000517:prevention & control*; D016544:Patient Simulation
keywords: Delphi; checklist; omissions; simulated cardiopulmonary bypass