“Here is a checklist….run the code.”

by Darin Abbey

Prior to flight, as the story goes the team in airplane cockpits employ the crew resource management strategy of “the sterile cockpit.” As I understand this practice, once established, the team in the cockpit can only talk about the task ahead which through the use of pre-flight checklists focuses the efforts, decreases distraction, and assures that key responsibilities are enacted. As a team, they may or may not have trained together, but as an industry the roles and the responsibilities are well understood. Informed through an ongoing series of case based iterations, flight crews have multiple checklists available to them. These checklists are finely honed and they assure that a commonality of practice is established. If things do not go well, the co-pilot may be asked to take control of the plane while the captain troubleshoots the situation.

Prior to your next code, can you imagine mirroring this arrangement with your Code Blue team? Can you imaging the team pre-briefing roles and responsibilities, honing in on lessons learned from recent events and reviewing checklists. Can you imagine “the sterile cockpit” being used to assure that only necessary conversation occurs? Can you imagine the code leader physician, turning to the code leader nurse and asking for the code to be run, while reversible causes are searched for?

As an industry might healthcare be able to prepare together and practice this way? What barriers can you imagine? How might they be overcome? What systems are in place to learn from recent events in the setting where you work? What role do checklists play in your resuscitations?

 

Suggested reading and to learn more:

Ornato, J. and Peberdy, M. (2014) Applying lessons from commercial aviation safety and operations to resuscitation. Resuscitation 85 173– 176

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