Objectives & Background The Emergency Department (ED) is a fertile ground for medical error. In numerous other areas checklists (and the associated cultural changes) have been brought in to reduce error. Following the National Audit Project into airway complications in 2011, guidelines were produced recommending the use of a checklist prior to rapid sequence induction (RSI) along with capnography in the ED. Similarly, College of Emergency Medicine (CEM) guidelines recommended ‘checks’ prior to sedation and capnography use. The project objectives were firstly to review the national use of checklists (and capnography). Secondly, within one trust which has already implemented the checklists, to ascertain if they were used in reality. Finally, the study looked into attitudes and how barriers to implementation could be overcome.

Methods A telephone survey of all English Emergency Departments was conducted to determine the use of checklists (and capnography) for intubation and sedation. Within Brighton and Sussex University (BSUH) NHS trust, a retrospective notes audit was conducted to determine checklist use. Finally, staff involved in patient care were interviewed regarding their experiences of checklists.

Results 138 out of 178 EDs agreed to take part in the survey. 48.6% and 58% of the EDs reported using a RSI and sedation checklist, respectively. An association (p<0.0003) between checklist use and capnography in sedation was identified. The audit data from BSUH NHS trust showed checklists were used in 21.5% of RSIs and 57.8% of sedations. Interviews showed that barriers included problems of implementation across multiple specialties and overcoming staff's pre-conceived attitudes towards the checklists.

Conclusion The use of checklists within Emergency Medicine remains limited. Their uptake within a trust that has implemented them has been slow. Cultural resistance within the workplace remains a barrier that needs to be overcome.