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International Journal for Quality in Health Care Advance Access originally published online on December 11, 2007
International Journal for Quality in Health Care 2008 20(1):22-30; doi:10.1093/intqhc/mzm062
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© The Author 2007. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved

Development of medical checklists for improved quality of patient care

Brigette Hales1, Marius Terblanche2, Robert Fowler1 and William Sibbald1

1 Sunnybrook Health Sciences Centre, Toronto, Canada
2 Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom

Background. Checklists are used in both medical and non-medical industries as cognitive aids to guide users through accurate task completion. Their development requires a systematic and comprehensive approach, particularly when implemented in high intensity fields such as medicine.

Objective. A narrative review of the literature was conducted to outline the methodology to designing and implementing clear and effective medical checklists.

Methods. We systematically searched for relevant English-language medical and non-medical literature both to describe where checklists have been demonstrated to improve delivery of care and also, how to develop valid checklists.

Results. The MEDLINE search yielded 8303 citations of which 1042 abstracts were reviewed. On the basis of criteria for inclusion and subsequent full-manuscript review, 178 sources, including 17 non-medical publications, were included in the narrative review. This information was further supplemented by expert opinion in the area of checklist development and implementation. A small number of strategies for designing effective checklists were referenced in the literature, including utilization of pre-published guidelines, formation of expert panels and repeat pilot-testing of preliminary checklists.

Conclusion. Despite currently available evidence, a highly effective, standardized methodology for the development and design of medical-specific checklists has not previously been developed and validated, which has likely contributed to their inconsistent use in several key fields of medicine, despite evidence of their fundamental role in error management.

Keywords: checklist, design methodology, mnemonic device, patient safety, quality improvement

1 Address reprint requests to: Brigette Hales, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue C829, Toronto, ON M4N 3M5. Tel: +416 480-6100 ext 88133; Fax: +416 480-5385; E-mail: brigette.hales{at}sunnybrook.ca, bhales{at}hotmail.com

Accepted for publication November 4, 2007.


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