Improving checklist usage on the ICU: making it electronic and dynamic.
A.J.R. De Bie1, S. Nan2,5, L.R.E. Vermeulen 2,3, P.M.E. van Gorp2, U. Kaymak3, A.J.G.H. Bindels3, H.H.M. Korsten3,4.
1 Department of Internal Medicine, Catharina Hospital Eindhoven, Eindhoven, the Netherlands
2 Industrial Engineering & Innovation Sciences, Eindhoven University of Technology, Eindhoven, The Netherlands.
3 Department of Intensive Care Unit, Catharina Hospital, Eindhoven, The Netherlands.
4 Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
5 School of Biomedical Engineering and Instrumental Science, Zhejiang University, Hangzhou, China
Background
More evidence indicates that medical checklists are able to reduce errors in a cost-effective manner
and improve the quality of medical care. However, the acceptance and compliance by clinicians
remain challenges. We developed an electronic dynamic checklist (EDC) with the ability to check
items automatically based on information in the electronic medical records.
Objective
The aim of this study is to explore the effectiveness and acceptance of an EDC for daily rounds on the
intensive care unit (ICU).
Methods
A simulation study was conducted to compare the EDC with the standard of care, with the possibility
to use the comparable paper checklist. We selected six typical ICU scenarios, implemented several
flaws and established a golden standard for items that needed to be checked. Issues requiring an
intervention were called critical checks. Participants, intensivists and residents of the ICU of the
Catharina Hospital in Eindhoven, were divided in two groups. The first group performed scenario 1-3
by daily routine and scenario 4-6 with the EDC, the second group performed the scenarios in
reversed order. Surveys on usefulness and acceptance of the EDC were collected afterwards. The
measured outcomes were the acceptance score for the EDC and the percentage of checked items
and critical checks.
Results
Twenty participants were included, who performed 116 scenarios. The mean percentage of checked
items was 99% (SD = 2) using the EDC, compared to 69% (SD = 15) for participants who only had a
paper checklist available (p<0.001). Of the critical checks 1% (SD=4) remained unchecked if the EDC
was used, compared to 26% (SD=21) in standard care (p<0.001). The mean acceptance score was
4.13 out of 5 (SD = 0.46).
Conclusion
This simulation study indicates that using an EDC significantly increases the amount of checked items
and the acceptance score of the EDC is high.