• communications
• emergency department operations
• errors
• guidelines
• prehospital care

In terms of time and financial cost, the humble checklist is arguably one of the most effective methods of reducing medical error and improving performance under pressure. Checklists help to ensure all steps in a task are completed and they reduce stress prior to undertaking high-risk procedures. They improve teamwork effectiveness and reduce cognitive overload when patent deterioration or equipment failure occurs.

In 2008 WHO introduced the surgical safety checklist: this has become embedded internationally within safe theatre practice. These checklists have led to reductions in surgical errors, complications and death. They have also been associated with cost savings, improved communication within the operating team and improved attitudes and cultures regarding patient safety.1 Many will have read Atul Gawande’s ‘The Checklist Manifesto’ which not only describes the successful development and introduction of preoperative surgical checklists but importantly also describes some of the barriers to the success of implementation.2 Gawande describes how some operating theatre staff perceived them to slow productivity and to suppress individual practice and flexibility, placing higher value on clinical autonomy.

The use of checklists to support patient care in emergency medicine and prehospital care is increasing. The quality and utility of checklists in medicine is however variable. It is essential that checklists are appropriately designed and worded and are thoroughly tested prior to their introduction into clinical settings. A checklist that has too many steps may risk delaying the start of a time-critical …