The Checklist Manifesto (Metropolitan Books, 2009) is the latest provocative and well-written book by Harvard surgeon and New Yorker writer Atul Gawande. Here, he tackles the subject of minimizing human error by implementing checklists.

While attempting to come up with a strategy to reduce worldwide surgical errors, Gawande learns that checklists are essential to other complex, high pressure tasks, such as building skyscrapers and flying jets. Rigorous use of established checklists have ensured safe building design and have prevented many airline disasters, as recently as the successful water landing of US Airways 1549 in the Hudson River in January 2009. In health care, Gawande reports Dr. Peter Pronovost’s successful use of a checklist to prevent infections in patients with central intravenous catheters.

Later in the book, Gawande shows that his safe surgery checklist has had incredible success around the world. Eight hospitals in rich and poor countries have seen postsurgical complications drop by 36% and deaths by 47% after six months of using a simple checklist. Since checklists cannot include every step in a complex process, a key step in most successful ones involves stopping to communicate about potential problems.

Gawande notes that many skeptics feel their jobs are too complicated to be reduced to a simple checklist. But he shows that even in his own practice of high-risk endrocrine cancer surgery, a checklist has regularly detected errors and prevented at least one death.

Can a checklist be of value in a busy pediatric office? Each day in my general pediatric practice, there are real or potential lapses in care due to inadequate exam room preparation, missing or misfiled documents, malfunctioning equipment, incomplete vital signs, or my own memory limitations. Checklists may have a role in the pediatric office: want to give them a try?

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