WOMEN'S HEALTH TECH REPORT: Your Checklist Is a PDF. That’s the Problem.
Why obstetric journals keep publishing paper checklists in the age of AI, and why patients deserve better.
In 2024, the Society for Maternal-Fetal Medicine published an updated emergency checklist for placenta accreta spectrum in the American Journal of Obstetrics and Gynecology. The recommendation for how to deploy it? Laminate it and place copies in the OR, the code book, the anesthesia cart, and the hemorrhage cart.
Laminate it.
We have large language models that can process an entire patient chart in seconds, cross-reference drug interactions, adjust risk calculations in real time, and deliver context-specific guidance at the point of care. And the leading journal in our field is telling us to laminate a piece of paper.
I do not say this to be glib. I say it because there is a fundamental mismatch between the tools we publish and the tools that exist, and that mismatch has consequences for patient safety.
Checklists Work. The Problem Is How We Deliver Them.
Let me be clear about what I am not saying. I am not saying checklists are useless. The evidence is strong. The WHO Surgical Safety Checklist reduced surgical mortality by 47% and complications by 36% in its original pilot across eight countries. In obstetrics, oxytocin checklists have improved neonatal outcomes. Cesarean delivery safety checklists, published by SMFM in AJOG in 2021, address the unique complexity of two patients with separate care teams. The concept is sound.
What is not sound is the delivery mechanism. A paper checklist, however well designed, has structural limitations that no amount of lamination can fix.
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