by Roger I. Ceilley, MD, FAAD, FCMS, and Shandhan Sureshbabu, CDT
Dr. Ceilley and Mr. Sureshbabu are with Dermatology P.C. in West Des Moines, Iowa.
FUNDING: No funding was provided for this article.
DISCLOSURES: The authors declare no conflicts of interest relevant to the content of this article.
ABSTRACT: This article explains the value and rationale behind the use of checklists. Included is a surgery checklist used successfully over many years by a highly experienced dermatologist and dermatologic surgeon. This approach is used by all clinicians and office staff in a very busy ambulatory practice that incorporates medical, cosmetic, and surgical dermatology, including Mohs micrographic surgery.
Life and the practice of medicine are becoming increasingly complex. However, there is a straightforward method that can enhance the quality, safety, and efficiency of your practice: the checklist. This method has been invaluable not only in our clinical practice, but also my professional life.
Benefits of checklists in dermatologic surgery
Precision and meticulous attention to detail are critically important in dermatologic surgery. Checklists are essential tools that enhance patient safety and procedural consistency. The delicate nature of skin surgeries, which often involve areas with high cosmetic importance, makes the use of checklists particularly valuable. Key benefits include:
Error reduction. Errors such as wrong-site excisions, incomplete removal of lesions, or inadequate hemostasis can have significant consequences for patient outcomes. Checklists serve as a safeguard and ensure that critical steps, such as confirming the surgical site, verifying lesion margins, and checking for issues that may impact hemostasis are consistently performed. This systematic approach reduces the risk of overlooking essential aspects of the procedure.
Consistency in care.The high volume of routine procedures, such as excisions, biopsies, and Mohs surgeries, requires a consistent approach to maintain quality. Checklists guarantee that each procedure is conducted with the same level of rigor, regardless of the individual performing the surgery. Consistency is very important in dermatologic surgery. Minor deviations can lead to complications and significant differences in cosmetic outcomes or recurrence rates. This coordination reduces intraoperative delays and enhances the overall efficiency of the procedure.
Patient safety and satisfaction. Dermatologic surgeries often deal with both functional and cosmetic outcomes, making patient safety and satisfaction paramount. By establishing attention to detail and reducing the risk of errors, checklists contribute to better healing, fewer complications, and more satisfactory cosmetic results. Patients are more likely to feel confident in their care when they know that a structured approach is being followed.
Creating an exceptional checklist
Developing an effective checklist for dermatologic surgery involves careful consideration of both the specific requirements of the procedures and the practical aspects of its use. To create a checklist that is both functional and effective, it must fulfill the following criteria:
Concise and focused.It is essential that checklists be concise, focusing on the most critical steps required to provide patient safety and surgical success. By limiting the checklist to necessary tasks, you prevent “checklist fatigue,” which can occur when the checklist becomes too long or cumbersome. The goal is to create a tool that enhances the surgical process without overwhelming the team.
Tailored to the practice. Every dermatology practice has a unique set of procedures and preferences. A surgical checklist should reflect these nuances. It should include specific steps for commonly performed surgeries in your practice, such as Mohs surgery, melanoma excisions, and excisional biopsies. This customization ensures the checklist is directly relevant and valuable to your team.
User-friendly. The checklist must be easy to use, with clear and unambiguous language that guides the team through each step of the procedure. It should follow the natural sequence of the surgical workflow that integrates smoothly into the process. A well-designed checklist should be easy to complete, providing essential reminders without interrupting the flow of the surgery. In our practice, we use a laminated sheet with an ink marker that can be wiped clean with alcohol (Figure 1).
Regularly updated. Best surgical practices evolve over time, and your checklist should too. Regular updates are crucial to keep the checklist relevant and effective. This can involve incorporating new safety protocols, addressing feedback from the surgical team, or integrating the latest evidence-based practices. A living document approach provides a checklist that remains a powerful tool in improving surgical outcomes.
Practice implications
In our dermatology practice, the implementation of checklists has profoundly influenced the quality of care and safety across all surgical procedures. The use of checklists supports risk management by ensuring that potential issues are identified and addressed before they escalate. For instance, confirming patient allergies or reviewing the plan for hemostasis can prevent complications. Additionally, the checklist serves as a tool for continuous quality control, allowing for the documentation and analysis of any deviations from the standard protocol. The checklist is a cornerstone of our surgical process, assuring that every patient receives the highest standard of care.
Conclusion
Checklists are invaluable tools in dermatologic surgery that offer numerous benefits, including enhanced patient safety, improved team coordination, and more consistent care. By following the principles of “The Checklist Manifesto”1 and Dermatologic Surgery textbooks,2,3 while tailoring checklists to the specific needs of the practice, dermatologic surgeons can significantly improve surgical outcomes. Our experience demonstrates that when checklists are effectively integrated into the surgical process, they become an essential component of high-quality patient care.
References
Gawande A. The Checklist Manifesto: How to Get Things Right.1st ed. Metropolitan Books; 2009:(2):32–45.
Kanto J. Preoperative Evaluation, Patient Preparation, and Informed Consent.Dermatologic Surgery, New York: McGraw-Hill Education, 2018:(3):44–48.
Wheeland R.G. Preoperative Patient Evaluation and Preparation for Cutaneous Surgery.Cutaneous Surgery. W.B. Saunders Company, 1994:(2):12–25.
Enhancing Safety in Dermatologic Surgery: The Impact of Checklist Implementation
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J Clin Aesthet Dermatol. 2024;17(12):16–17.
by Roger I. Ceilley, MD, FAAD, FCMS, and Shandhan Sureshbabu, CDT
Dr. Ceilley and Mr. Sureshbabu are with Dermatology P.C. in West Des Moines, Iowa.
FUNDING: No funding was provided for this article.
DISCLOSURES: The authors declare no conflicts of interest relevant to the content of this article.
ABSTRACT: This article explains the value and rationale behind the use of checklists. Included is a surgery checklist used successfully over many years by a highly experienced dermatologist and dermatologic surgeon. This approach is used by all clinicians and office staff in a very busy ambulatory practice that incorporates medical, cosmetic, and surgical dermatology, including Mohs micrographic surgery.
KEYWORDS: Dermatologic surgery, Mohs micrographic surgery, surgical dermatology, excision, biopsy, practice management
Life and the practice of medicine are becoming increasingly complex. However, there is a straightforward method that can enhance the quality, safety, and efficiency of your practice: the checklist. This method has been invaluable not only in our clinical practice, but also my professional life.
Benefits of checklists in dermatologic surgery
Precision and meticulous attention to detail are critically important in dermatologic surgery. Checklists are essential tools that enhance patient safety and procedural consistency. The delicate nature of skin surgeries, which often involve areas with high cosmetic importance, makes the use of checklists particularly valuable. Key benefits include:
Creating an exceptional checklist
Developing an effective checklist for dermatologic surgery involves careful consideration of both the specific requirements of the procedures and the practical aspects of its use. To create a checklist that is both functional and effective, it must fulfill the following criteria:
Practice implications
In our dermatology practice, the implementation of checklists has profoundly influenced the quality of care and safety across all surgical procedures. The use of checklists supports risk management by ensuring that potential issues are identified and addressed before they escalate. For instance, confirming patient allergies or reviewing the plan for hemostasis can prevent complications. Additionally, the checklist serves as a tool for continuous quality control, allowing for the documentation and analysis of any deviations from the standard protocol. The checklist is a cornerstone of our surgical process, assuring that every patient receives the highest standard of care.
Conclusion
Checklists are invaluable tools in dermatologic surgery that offer numerous benefits, including enhanced patient safety, improved team coordination, and more consistent care. By following the principles of “The Checklist Manifesto”1 and Dermatologic Surgery textbooks,2,3 while tailoring checklists to the specific needs of the practice, dermatologic surgeons can significantly improve surgical outcomes. Our experience demonstrates that when checklists are effectively integrated into the surgical process, they become an essential component of high-quality patient care.
References
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