On The Issues

October 9th, 2014

Bringing Electronic Checklists to Healthcare

Affording Patient Safety to all Healthcare Providers and Consumers

Doctors and surgeons are some of the brightest individuals in the world. However, no one is immune to mistakes and simple oversights. Unintentional errors occur in any industry; what makes healthcare different is that a single misstep could cost a life.  

In, The Checklist Manifesto by Dr. Atul Gawande, he cites a fellow surgeon’s story of a seemingly routine stab wound.  The patient was at a costume party when he got into an altercation that led to the stabbing.  As the team prepared to treat the wound, the patient’s vitals began dropping rapidly. The surgeon and his team were unaware that the weapon was a bayonet that went more than a foot through the man, piecing his aorta.
 
After regaining control of the situation, the man recovered after a few days. This experience presented complications that no one could possibly predict unless the doctors had full knowledge of the situation.  Gawande states, “everyone involved got almost every step right […] except no one remembered to ask the patient or the medical technicians what the weapon was” (Gawande 3). There are many independent variables to account for; a standard checklist for incoming stab wound patients could ensure that episodes like this are avoided and that other red flags would be accounted for. 
 
Miscommunication between clinicians and patients annually accounts for roughly 800,000 deaths in the US, more than heart disease and more than cancer.  The healthcare industry spends roughly $8 billion on extended care as a result of clinical error every year. As accountable care continues to make progress, the healthcare industry is moving more towards evidence based medicine and best practices. This is certainly the case for care providers, but also for patients as well. 
 
Implementing checklists in all aspects of healthcare can eliminate simple mistakes and common oversights by medical professionals and empower patients to become more educated and informed. Studies by the Journal of the American Medical Association (JAMA) as well as the New England Journal of Medicine (NEJM) have concluded that implementing checklists in various facets of care can reduce errors by up to half. Certain implementations of checklists in Intensive Care Units for infection mitigation resulted in reducing infections by 100 percent.
 
Compelling evidence of the need for checklisting can be found in the preparation process for a colonoscopy.  Colonoscopy preparation is a rigorous process that requires patients to be watching their diet and the clock for two days before procedure.  It is not uncommon for a colonoscopy to fail due to inadequate patient preparation. Before the procedure, the patient must pay attention to an arsenal of instructions regarding food, liquid, and medication. A detailed checklist that guides each patient through the process would practically eliminate any errors and failures due to inadequate patient preparation. 
 
From the patient’s perspective, checklisting everything from pre-surgery preparation to a routine checkup should be a priority.   At the end of the day, the patient has the most at stake and should be entitled to a clear, user-friendly system to understand every last detail of any procedure or treatment.
 
A couple of companies are making waves in the area of patient safety checklists, most notably of which are BluMenlo and Parallax.
 
BluMenlo is a mobile patient safety firm founded in 2012. Its desktop, tablet, and mobile solution drives utilization of checklists for patient handoffs, infection mitigation, and Radiation Oncology Machine QA. Although initial focus is in the areas mentioned, BluMenlo is expanding into standardizing best practices hospital and ACO-wide.
 
Parallax specializes in operating room patient safety. Its CHaRM offering incorporates a Heads Up Display to leverage checklists in the Operating Room. The software learns a surgeon’s habits and techniques to accurately predict how long an operation may take as well as predict possible errors.
 
Electronic checklists will certainly take hold as health systems, ACOs and accountable care networks continue to focus on increased patient safety, improved provider communications and best practices for reducing costs across their organizations. We will even see these best practices expedited if we begin to inquire with our care providers as informed and engaged patients.
 
What questions about checklists do you have?
 
As a healthcare executive and strategist, Justin Barnes is an industry and technology advisor who also serves as an Entrepreneur-in-Residence at Georgia Tech’s Advanced Technology Development Center. In addition, Mr. Barnes is Chairman Emeritus of the HIMSS EHR Association as well as Co-Chairman of the Accountable Care Community of Practice.