Preanesthesia detection of equipment faults by anesthesia providers at an academic hospital: comparison of standard practice and a new electronic checklist.

We hypothesized that our institutional standard practice for preanesthesia equipment checkout, based in part on US Food and Drug Administration recommendations, failed to detect a significant number of faults (absent or nonfunctional equipment). We designed a new, computer-based, highly interactive electronic checklist that emulated the checklist methods used in aviation and military settings and compared it to our standard practice in the detection of faulty equipment. Using a randomized, cross-over design, anesthesia providers searched for prearranged faults over a 2-day period using both the electronic and standard approaches. Faults (easy and difficult) found, faults missed, and time to complete the checkout were recorded. The electronic checklist was superior to standard practice in the detection of "easy" and "difficult" equipment faults. However, even when the electronic checklist was used, a high proportion of difficult faults were missed. Whether the failure represents a need for improved checkout procedures and provider training or better equipment design will require further study.