An Anesthesia Checklist: A Survey of Compliance and Attitudes

Document Type : Original Article


Department of Anesthesiology – South Infirmary – Victoria University Hospital, Cork, Ireland.


While anesthesia is regarded as one of the safest clinical specialties, continuing to ensure patient safety requires vigilance. The growing complexity of modern medicine makes it extremely dangerous to rely on the absence of human error. There is evidence to suggest that anesthesiologists are less inclined to use checklists than surgeons and nurses. Seniority has also been shown to dictate the acceptance of checklists.
Materials and Methods:
We assessed compliance with, and attitudes to an anesthesia checklist, comparing by seniority.
1. Analysed a representative sample (n=247, 95% CI, 5% ME) of general anesthesia cases performed in one year (n=747), calculating percentage compliance in each case. We compared groups by seniority with Mann-Whitney U testing using SPSS.
2. We assessed attitudes using a 20-item questionnaire, consisting of five themed sub-scales. Descriptive statistics were generated.
Mean total compliance with the checklist was 91.6% (95% CI: 90.6-92.6%). Non-Consultant compliance was estimated at 94.4% (95% CI: 93.0-95.8%), compared to 91.6% (95% CI: 89.5-93.7%) in the Consultant group. Higher Non-Consultant compliance was significant, compared to the Consultant group (P=0.045).
The Non-Consultant group demonstrated greater compliance. Attitudes to the checklist were similar amongst the two groups with lack of time and lack of training cited as two major barriers to use. Both senior and junior anesthesiologists felt it had a positive impact on patient safety.


  1. Staender SE, Mahajan RP. Anesthesia and patient safety: have we reached our limits? Curr Opin Anaesthesiol. 2011;24(3):349-53.
  2. Roberts KH, Rousseau DM. Research in nearly failure-free,high-reliability organizations: having the bubble. IEEE Transactions on Engineering Management. 1989;36(2):132-9.
  3. Roth R, Frost EAM, Gevirtz C. The Role of Anesthesia in Global Health: A Comprehensive Guide. Chapter 10. Springer; 2015.
  4.                 Haynes AB, Weiser TG, Berry WR, Lipsitz SR, Breizat A-HS, Dellinger EP, et al. A Surgical Safety Checklist to Reduce Morbidity and Mortality in a Global Population. New England Journal of Medicine. 2009;360(5):491-9.
  5.                 Borchard A, Schwappach DLB, Barbir A, Bezzola P. A systematic review of the effectiveness, compliance, and critical factors for implementation of safety checklists in surgery. Ann Surg. 2012;256(6):925-33.
  6.                 O'Connor P, Reddin C, O'Sullivan M, O'Duffy F, Keogh I. Surgical checklists: the human factor. Patient Safety in Surgery. 2013;7(1):14.
  7.                 Krombach JW, Edwards WA, Marks JD, Radke OC. Checklists and other cognitive aids for emergency and routine anesthesia care-a survey on the perception of anesthesia providers from a large academic US institution. Anesthesiology and Pain Medicine. 2015;5(4).
  8.                 Tscholl DW, Weiss M, Kolbe M, Staender S, Seifert B, Landert D, et al. An Anesthesia Preinduction Checklist to Improve Information Exchange, Knowledge of Critical Information, Perception of Safety, and Possibly Perception of Teamwork in Anesthesia Teams. Anesth Analg. 2015;121(4):948-56.
  9.                 IBM Corp. Released 2016. IBM SPSS Statistics for Windows, Version 24.0. Armonk, NY: IBM Corp.
  10.                 Webster CS, Andersson E, Edwards K, Merry AF, Torrie J, Weller JM. Deviation from accepted drug administration guidelines during anesthesia in twenty highly realistic simulated cases. Anaesth Intensive Care. 2015;43(6):698-706.
  11.                 Urbach DR, Govindarajan A, Saskin R, Wilton AS, Baxter NN. Introduction of surgical safety checklists in Ontario, Canada. N Engl J Med. 2014; 370(11):1029-38.
  12.                 Gueguen T, Coevoet V, Mougeot M, Pierron A, Blanquart D, Voicu M, et al. Deployment of the checklist "Patient safety in the operating room" in two Lorraine hospitals. Performances and difficulties. Ann Fr Anesth Reanim. 2011; 30(6): 489-94.
  13.                 Gawande A. The checklist manifesto: how to get things right. Picador UK. 2010.
  14.                 Sewell M, Adebibe M, Jayakumar P, Jowett C, Kong K, Vemulapalli K, et al. Use of the WHO surgical safety checklist in trauma and orthopaedic patients. Int Orthop. 2011; 35(6): 897-901.