Starting Off Right: Checklists Are Essential for a Good History

Part 1 of a 3-part series

A thorough, focused, relevant medical history is essential to develop a complete patient problem list, achieve high diagnostic accuracy, and maintain client satisfaction. In human medicine, a 2013 study showed 37% of medical students failed a clinical competency examination because of unsatisfactory medical interviews.¹ For this reason, checklists have become increasingly popular in human medicine, and veterinary professionals can learn from physicians how to best use history checklists.

Successful history-taking should be structured to collect pertinent, factual information in a logical, step-wise fashion about the presenting complaint, past medical history, and environmental exposures.² The history-taker must be able to focus on the patients presenting complaint and extract relevant medical information, and he or she should communicate clearly using open-ended questions, empathy, nonverbal cues, and reflective listening to evaluate the clients goals and concerns.

The Case for Checklists

An accurate, complete medication history is important for many reasons, including:

• Identifying patient adverse events

• Identifying and correcting medication errors

• Recognizing noncompliance that may explain a patients illness

• Minimizing errors that may result in interrupted, inappropriate, or harmful treatment during hospitalization³

But, errors made taking medication histories are alarmingly common¹ study showed mistakes occurred in 67% of cases.³

A checklist provides a structured or algorithm-based method of taking a medical history, which can significantly improve accuracy and completeness.^4-6 Algorithm use has the added benefit of allowing a team member other than the veterinarian to complete the medical interview, which can improve efficiency during an office visit, help standardize quality and thoroughness of the content,⁵ minimize errors, and improve patient care.⁵ Also, history-taking checklists are easy, quick, and inexpensive to incorporate into a veterinary practice. (See General History Veterinary Checklist.)

History-Taking 101

Medical students who receive general communication training have better interpersonal skills and are able to obtain more complete medical histories,^1,7 but specific training on implementing history-taking checklists and using them to categorize a large number of facts into simpler patterns might also be helpful.^7,8

History-taking can be taught using many methods, including videos, online courses (see Resources), and experiential, hands-on approaches (eg, small group workshops, feedback with role-play or simulated clients⁷), as well as actual practice and experience.

Communication & Teamwork

Checklists can also complement the history-taking process by minimizing human error through enhanced communication and facilitation of better teamwork.

One high-profile example of checklist-enhanced communication and teamwork is the Surgical Safety Checklist (SSC) developed by the World Health Organization in 2006 and implemented in more than 4000 human hospitals worldwide.⁹ The SSC outlines a series of verbal checks among team members performed at key times before, during, and after surgery. Studies support the SSCs positive impact, including a significant reduction in perioperative morbidity and mortality as one measurable outcome.^9-12

Implementing such a new system requires a deliberate, coordinated team effort,¹³ and practices must embrace an interactive leadership team, explain value, build enthusiasm, invest in training, encourage feedback, and make local modifications to ensure success.¹³ The SSC is successful because communication and accountability are improved in high-risk situations and complications are reduced.^9,10

Conclusion

Checklists have been shown to benefit human medicine, particularly when complemented with communication training. Using checklists can minimize errors, improve patient safety, enhance efficiency, and build better teams with stronger rapport, and can especially benefit team members who have less clinical experience.¹⁴ Veterinary professionals should learn from the human field and incorporate a standardized medical history checklist in their practices.