Fabrizio Dal Moro, Assistant Professor,

Other Contributors:

August 13, 2014

Dear Editor, we would like to congratulate Russ et al. on their paper on the patients' views of surgical checklists (SC). In their elegant work, the above authors underlined that assessing the fidelity of the SC remains a challenge, but demonstrated a high level of patient support for use of checklists. They found that patients were surprised that SC was only a recent introduction to surgical care. Moreover, the authors stressed that the majority of patients agreed that they would like the SC to be used if they were having an operation. In our experience, we confirm that the value of SC does not lie in the so- called Hawthorne effect, but in changing (improving!) the mental model. As also documented in the field of aviation, most accidents tend to involve non-technical skills (NTS) such as communications, leadership, conflict, and flawed decision-making. The relationship between NTS and human error has been extensively demonstrated. In Aviation it is mandatory for pilots to read a checklist for every single phase of flight. Of course they know the checklists by heart, but what are stressed, the last leg of the day, distracted, with family problems? Of course it may be that you don't need any checklist, but will you risk it? Will you risk to take off from Toronto under snow knowing that pilots didn't read any checklist because they know procedures by heart and because statistics say it doesn't matter, and results are the same..?

We would like conclude that one of the effective barriers to error is the surgery safety checklist and, believe it or not, we are sure that pilots if going under surgery they would like to know that surgeon uses appropriate checklists that day!

____________________________________________________________ Fabrizio Dal Moro is an Assistant Professor at the University of Padova, expert on NTS.

Gianluigi Zanovello and Fabio Cassan are airline pilots in Italy: Zanovello is a former "Frecce Tricolori" (italian acrobatic team) leader; Cassan was fighter squadron commander (51' Stormo Aeronautica Militare Italiana).

They teach at Practice simulation center in the medicine University of Verona - Italy. There, surgeons can practice exactly like the pilots and run-through not only the anatomy before the real procedure. There is something else: get familiar with NTS and understand that communication, decision making, teamwork, situation awareness are important as the professional, and technical.

Conflict of Interest:

None declared

Conflict of Interest

None declared