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Comment by noir_lord | Hacker News Reader

The tragedy here is that checklists where invented for dealing with complex common situations under stress (iirc they where popularised not sure if invented in the modern form as a way to allow pilots to fly a much more complex aircraft than preceeding models[1]).

http://www.atchistory.org/History/checklst.htm

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Indeed - the corresponding research into checklistbundles indicated that they would be quite effective; but I think the lack of anything like 100% uptake is due to the lack of appropriate technology to easily create, maintain and utilise checklistbundles.

I really doubt that... I'm pretty sure the reason for lack of uptake is organizational and social in nature. A checklist is the simplest thing in the world. I can make a checklist right now!

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Check-lists in medicine (and real life) are a lot more complex depending on the protocol and the patient and are more akin to complex business process flows - around which a whole industry has grown. A colleague in psychiatry spent 12 months designing a simple checklist and data collection form for initial patient evaluation.

Sure, but that doesn't sound like an impossible thing to deal with. There are many activities we undertake that are far more complex (collecting taxes for one!) and not every process is hard, you could hit the easy ones first. It's a question of will.

Will in one sense, herding cats in another ;).

It's a question of resources as well. Adding checklists means more time and audit needed. Let's say something initially took 30 secs (due to the muscle memory prowess of the health workers) but by using a checklist it gets down to 45 secs - a 50% increase in latency. If this process is done 10000 times a day (a respectable number if you consider high-volume processes like administering a drug):

* you might have just increased manpower requirements across the board by about 50%

* you might have just caused patients to wait over the phone 50% longer, or queue to get their medicine 50% longer, or wait for the discharge process to finish 50% longer...

The trick is to apply this cost only in places where preventing mistakes that are far more expensive. ;)

To be sure is not an impossible thing to deal with - but the 'cost of sale' is so high as to make it easier to just let patients suffer and die.

That seems.... unlikely. I'm sure the saving of forms filled out when patients die and malpractice trials results in a fairly large benefit in efficiency. Just pick the highly useful situations first, and don't do the stupid ones.

>> but I think the lack of anything like 100% uptake is due to the lack of appropriate technology to easily create, maintain and utilise checklistbundles.

How would such technology in ideal form would be like ? and how do current practical implementations look like ?

The ideal would be an on-screen overlay (HUD, MS Hololens) which has voice control, "Insert IV, checklist", it pops up, "Completed: Swab", "Completed: Step2".

Have the system then sync that to a central system so you have a real time status of every procedure/drug/intervention administered to a patient, voice control means no issues with hand contamination, paperwork to carry around (and forget) etc.

I think we'll probably get to that at some point especially if sub-vocal voice recognition catches on.

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