Presented September 3, 2025 at the 2025 APSF Stoelting Conference on “Transforming Maternal Care: Innovations and Collaborations to Reduce Morbidity and Mortality”
SUMMARY
Alex Hannenberg, MD’s presentation argues for the urgent and widespread adoption of Digital Obstetric Crisis Checklists (or cognitive aids) to manage high-stress, low-frequency maternal emergencies. These tools combat the human factor challenge of relying on memory during a crisis, a necessity proven by dramatic reductions in critical step omissions during simulated events. The presentation highlights that the need for these tools is most acute in low-volume, rural, or safety-net facilities—the very places struggling most with maternal mortality—where rare emergencies are even rarer, and clinical experience is insufficient.
Key Points:
- Cognitive Aid Necessity
Obstetric emergencies are high-stress and rare, making it foolhardy to rely on memory for management [03:39, 03:50]. Cognitive aids (checklists, emergency manuals) provide real-time support to guide clinical care, training, and case review [00:24, 00:38]. - Proven Efficacy
Studies on crisis checklists demonstrate a dramatic improvement in clinician performance, with a 75% reduction in the omission of critical management steps during simulated critical events [05:24, 06:33]. - Intervention as Last Chance
Checklists are positioned as an intervention and the last and best chance to save a life when a life-threatening obstetric condition flares up [07:59, 08:06]. They are designed for non-routine operations when a crisis occurs [03:15, 03:23]. - Acute Need in Low-Volume Centers
The need for cognitive aids is most acute in obstetrical deserts, low-volume rural facilities, and safety-net hospitals [16:25, 17:18]. In these settings, rare events are even rarer, making it impossible for clinicians to maintain sufficient experience without structured support [16:45, 17:00]. - Culture of Humility
Successful adoption requires a cultural change and a foundation of humility among clinicians [18:09, 18:33]. Providers must accept that they could miss something, and using the checklist must be accepted as best practice, not a sign of incompetence, to ensure psychological safety [18:51, 18:57]. - Debriefing Integration
Modern checklists are being updated to include a concise outline for critical event debriefing to ensure the necessary steps are performed in a psychologically safe way, addressing a major barrier to post-event learning [15:57, 16:17].
ABOUT THE SPEAKER(S)
Alex Hannenberg, MD
Senior Research Scientist, Core Faculty Member,
Ariadne Labs, Harvard TH Chan School of Public Health and Brigham & Women’s Hospital
Adjunct Clinical Professor of Anesthesiology,
Tufts University School of Medicine
Alex Hannenberg, MD was the 2010 president of the American Society of Anesthesiologists (ASA) and recently served as its Chief Quality Officer. He is senior research scientist and core faculty member at Ariadne Labs, a health systems innovation center at the Harvard TH Chan School of Public Health and Brigham & Women’s Hospital where he works on surgical safety programs including checklists for critical event management and team-based case review implementation. He led the development of a simulation-based, low-barrier training framework adopted by the American Hospital Association, the Agency for Healthcare Research & Quality (TeamSTEPPS 3.0) and the Anesthesia Patient Safety Foundation. He was previously a director and chair of the national Council on Surgical and Perioperative Safety. He was chosen by the Anesthesia Patient Safety Foundation to deliver the annual Ellison C. Pierce Jr. Patient Safety Lecture in 2016.
In 2011, he joined with an international group of surgeons and anesthesiologists to create the Lifebox foundation, a charity focused on improving outcomes of surgery and anesthesia globally: “Saving Lives Through Safer Surgery.” He remains a trustee and is now chair of the foundation.
He is Adjunct Clinical Professor of Anesthesiology at Tufts University School of Medicine.
He has been recognized for his work with ASA’s highest honor, the Distinguished Service Award and was elected to Honorary Membership in the Association of Anaesthetists of Great Britain and Ireland.
