Advertisement

Design and implementation of a platform for configuring clinical dynamic safety checklist applications

  • Shan Nan
  • Xu-dong Lu
  • Pieter Van Gorp
  • Hendrikus H. M. Korsten
  • Richard Vdovjak
  • Uzay Kaymak
  • Hui-long Duan
Article
  • 22 Downloads

Abstract

In recent years, it has been demonstrated that checklists can improve patient safety significantly. To facilitate the effective use of checklists in daily practice, both the medical community and the informatics community propose to implement checklists in dynamic checklist applications that can be integrated into the clinical workflow and that is specific to the patient context. However, it is difficult to develop such applications because they are tightly intertwined with the content of specific checklists. We propose a platform that enables access to dynamic checklist applications by configuring the infrastructures provided in the platform. Then, the applications can be developed without time-consuming programming work. We define a number of design criteria regarding point of care and clinical processes by analyzing the existing checklist applications and the lessons learned from implementations. Then, by applying rule-based clinical decision support and workflow management technologies, we design technical mechanisms to satisfy the design criteria. A dynamic checklist application platform is designed based on these mechanisms. Finally, we build a platform in various design cycle iterations, driven by multiple clinical cases. By applying the platform, we develop nine comprehensive dynamic checklist applications with 242 dynamic checklists. The results demonstrate both the feasibility and the overall generic nature of the proposed approach. We propose a novel platform for configuring dynamic checklist applications. This platform satisfies the general requirements and can be easily configured to satisfy different scenarios in which safety checklists are used.

Key words

Checklist Workflow Clinical decision support Process management Patient safety 

CLC number

C936 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Amarasingham R, Pronovost PJ, Diener–West M, et al., 2007. Measuring clinical information technology in the ICU setting: application in a quality improvement collaborative. J Am Med Inform Assoc, 14(3):288–294.  https://doi.org/10.1197/jamia.M2262 CrossRefGoogle Scholar
  2. Anthes E, 2015. Hospital checklists are meant to save lives—so why do they often fail? Nature, 523(7562):516–518.  https://doi.org/10.1038/523516a CrossRefGoogle Scholar
  3. Arriaga AF, Bader AM, Wong JM, et al., 2013. Simulationbased trial of surgical–crisis checklists. N Engl J Med, 368(3):246–253.  https://doi.org/10.1056/NEJMsa1204720 CrossRefGoogle Scholar
  4. Avrunin GS, Clarke LA, Osterweil LJ, et al., 2012. Smart checklists for human–intensive medical systems. IEEE/IFIP Int Conf on Dependable Systems and Networks Workshops, p.1–6.  https://doi.org/10.1109/DSNW.2012.6264661 CrossRefGoogle Scholar
  5. Baker GR, Norton PG, Flintoft V, et al., 2004. The Canadian adverse events study: the incidence of adverse events among hospital patients in Canada. CMAJ, 170(11):1678–1686.  https://doi.org/10.1503/cmaj.1040498 CrossRefGoogle Scholar
  6. Borchard A, Schwappach DLB, Barbir A, et al., 2012. A systematic review of the effectiveness, compliance, and critical factors for implementation of safety checklists in surgery. Ann Surg, 256(6):925–933.  https://doi.org/10.1097/SLA.0b013e3182682f27 CrossRefGoogle Scholar
  7. de Bie AJR, Nan S, Vermeulen LRE, et al., 2017. Intelligent dynamic clinical checklists improved checklist compliance in the intensive care unit. Br J Anaesth, 119(2):231–238.  https://doi.org/10.1093/bja/aex129 CrossRefGoogle Scholar
  8. de Vries EN, Hollmann MW, Smorenburg SM, et al., 2009. Development and validation of the SURgical PAtient Safety System (SURPASS) checklist. Qual Saf Health Care, 18(2):121–126.  https://doi.org/10.1136/qshc.2008.027524 CrossRefGoogle Scholar
  9. de Vries EN, Prins HA, Crolla RMPH, et al., 2010. Effect of a comprehensive surgical safety system on patient outcomes. N Engl J Med, 363(20):1928–1937.  https://doi.org/10.1056/NEJMsa0911535 CrossRefGoogle Scholar
  10. Fourcade A, Blache JL, Grenier C, et al., 2012. Barriers to staff adoption of a surgical safety checklist. BMJ Qual Saf, 21(3):191–197.  https://doi.org/10.1136/bmjqs-2011-000094 CrossRefGoogle Scholar
  11. Garg T, Lee JY, Evans KH, et al., 2015. Development and evaluation of an electronic health record–based bestpractice discharge checklist for hospital patients. Jt Commiss J Qual Patient Saf, 41(3):126–131.  https://doi.org/10.1016/S1553-7250(15)41017-7 CrossRefGoogle Scholar
  12. Gooch P, Roudsari A, 2011. Computerization of workflows, guidelines, and care pathways: a review of implementation challenges for process–oriented health information systems. J Am Med Inform Assoc, 18(6):738–748.  https://doi.org/10.1136/amiajnl-2010-000033 CrossRefGoogle Scholar
  13. Grigg E, 2015. Smarter clinical checklists: how to minimize checklist fatigue and maximize clinician performance. Anesth Analg, 121(2):570–573.  https://doi.org/10.1213/ANE.0000000000000352 CrossRefGoogle Scholar
  14. Hassell LA, Parwani AV, Weiss L, et al., 2010. Challenges and opportunities in the adoption of College of American Pathologists checklists in electronic format: perspectives and experience of Reporting Pathology Protocols Project (RPP2) participant laboratories. Arch Pathol Lab Med, 134(8):1152–1159. https://doi.org/www.archivesofpathology.org/doi/10.1043/2009-0386-OA.1 Google Scholar
  15. Haynes AB, Weiser TG, Berry WR, et al., 2009. A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med, 360(5):491–499.  https://doi.org/10.1056/NEJMsa0810119 CrossRefGoogle Scholar
  16. Idahosa O, Kahn JM, 2012. Beyond checklists: using clinician prompts to achieve meaningful ICU quality improvement. Crit Care, 16(1), Article 305.  https://doi.org/10.1186/cc11199 Google Scholar
  17. Liu SS, Togioka BM, Hurley RW, et al., 2010. Methodological quality of randomized controlled trials of postoperative epidural analgesia: validation of the epidural analgesia trial checklist as a specific instrument to evaluate methodology. Reg Anesth Pain Med, 35(6):549–555.  https://doi.org/10.1097/AAP.0b013e3181fa114e CrossRefGoogle Scholar
  18. Malhotra S, Jordan D, Shortliffe E, et al., 2007. Workflow modeling in critical care: piecing together your own puzzle. J Biomed Inform, 40(2):81–92.  https://doi.org/10.1016/j.jbi.2006.06.002 CrossRefGoogle Scholar
  19. Mullan PC, Macias CG, Hsu D, et al., 2014. A novel briefing checklist at shift handoff in an emergency department improves situational awareness and safety event identification. Pediatr Emerg Care, 31(4):231–238.  https://doi.org/10.1097/PEC.0000000000000194 CrossRefGoogle Scholar
  20. Nan S, van Gorp P, Korsten HHM, et al., 2014. Tracebook: a dynamic checklist support system. IEEE 27th Int Symp on Computer–Based Medical Systems, p.48–51.  https://doi.org/10.1109/CBMS.2014.33 Google Scholar
  21. Nan S, Lu X, Yang Z, et al., 2017. An intelligent support system for patient safety checklists. Chin J Biomed Eng, 36(3):329–335 (in Chinese).  https://doi.org/10.3969/j.issn.0258-8021.2017.03.010 Google Scholar
  22. Pageler NM, Longhurst CA, Wood M, et al., 2014. Use of electronic medical record–enhanced checklist and electronic dashboard to decrease CLABSIs. Pediatrics, 133(3):738–746.  https://doi.org/10.1542/peds.2013-2249 CrossRefGoogle Scholar
  23. Peleg M, 2013. Computer–interpretable clinical guidelines: a methodological review. J Biomed Inform, 46(4):744–763.  https://doi.org/10.1016/j.jbi.2013.06.009 CrossRefGoogle Scholar
  24. Russ SJ, Sevdalis N, Moorthy K, et al., 2015. A qualitative evaluation of the barriers and facilitators toward implementation of the WHO surgical safety checklist across hospitals in England: lessons from the “Surgical Checklist Implementation Project”. Ann Surg, 261(1):81–91.  https://doi.org/10.1097/SLA.0000000000000793 CrossRefGoogle Scholar
  25. Rydenfält C, Ek Å, Larsson PA, 2014. Safety checklist compliance and a false sense of safety: new directions for research. BMJ Qual Saf, 23(3):183–186.  https://doi.org/10.1136/bmjqs-2013-002168 CrossRefGoogle Scholar
  26. Shillito J, Arfanis K, Smith A, 2010. Checking in healthcare safety: theoretical basis and practical application. Int J Health Care Qual Assur, 23(8):699–707.  https://doi.org/10.1108/09526861011081831 CrossRefGoogle Scholar
  27. Thongprayoon C, Harrison AM, O’Horo JC, et al., 2014. The effect of an electronic checklist on critical care provider workload, errors, and performance. J Intens Care Med, 31(3):205–212.  https://doi.org/10.1177/0885066614558015 CrossRefGoogle Scholar
  28. Weiser TG, Haynes AB, Lashoher A, et al., 2010. Perspectives in quality: designing the WHO surgical safety checklist. Int J Qual Health Care, 22(5):365–370.  https://doi.org/10.1093/intqhc/mzq039 CrossRefGoogle Scholar
  29. Wenzel RP, Edmond MB, 2006. Team–based prevention of catheter–related infections. N Engl J Med, 355(26): 2781–2783.  https://doi.org/10.1056/NEJMe068230 CrossRefGoogle Scholar
  30. Ziewacz JE, Arriaga AF, Bader AM, et al., 2011. Crisis checklists for the operating room: development and pilot testing. J Am Coll Surg, 213(2):212–217.e10  https://doi.org/10.1016/j.jamcollsurg.2011.04.031 CrossRefGoogle Scholar

Copyright information

© Zhejiang University and Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Biomedical EngineeringZhejiang UniversityHangzhouChina
  2. 2.School of Industrial EngineeringEindhoven University of TechnologyEindhoventhe Netherlands
  3. 3.Department of Aneasthiaology and Intensive-CareCatharina ZiekenhuisEindhoventhe Netherlands
  4. 4.Philips Research EindhovenEindhoventhe Netherlands

Personalised recommendations