Bundles and checklists

In the complex world of modern medicine, clinicians face two primary challenges in ensuring that the right care is delivered without error. First, humans are prone to making errors. A common refrain in most healthcare literature is that "to err is human. " Indeed, the human mind is fallible and makes errors at alarming rates. Even for simple, repetitive tasks, humans are prone to lapses of memory and attention. A second cause of error is that humans often take shortcuts, skipping steps that appear redundant, particularly in repetitive processes, and trading time or effort for what are judged to be superfluous steps. For example, even for patients undergoing the highest complexity procedures, such as complex congenital heart surgery, simple omissions can have major consequences. A successful surgery requires much more than a competent surgeon, anesthesiologist, and operating room personnel. In practice, it requires that the patient is appropriately prepped, that the planned procedure and approach are understood by all team members, that all equipment is available and functioning correctly, and that potential complications are considered. Each of these steps needs to be repeated each time to ensure an optimal outcome. Despite earnest preparation, omitting a simple step, which may seem self-evident, such as verifying a patient's allergies or marking the correct surgical site, can lead to disastrous consequences. To mitigate human error, healthcare systems around the world have implemented important quality tools. Two of the most common interventions with robust supporting evidence are the practice of bundles and checklists. In this chapter, we describe how bundles and checklists can be used to improve healthcare safety by empowering the delivery of consistent, high fidelity care.