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.

一种临床动态安全清单系统配置平台的设计与实现

[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.

[2]Anthes E, 2015. Hospital checklists are meant to save lives–-so why do they often fail? Nature, 523(7562):516-518.

[3]Arriaga AF, Bader AM, Wong JM, et al., 2013. Simulation-based trial of surgical-crisis checklists. N Engl J Med, 368(3):246-253.

[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.

[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.

[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.

[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.

[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.

[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.

[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.

[11]Garg T, Lee JY, Evans KH, et al., 2015. Development and evaluation of an electronic health record-based best-practice discharge checklist for hospital patients. Jt Commiss J Qual Patient Saf, 41(3):126-131.

[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.

[13]Grigg E, 2015. Smarter clinical checklists: how to minimize checklist fatigue and maximize clinician performance. Anesth Analg, 121(2):570-573.

[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. http://www.archivesofpathology.org/doi/10.1043/2009-0386-OA.1

[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.

[16]Idahosa O, Kahn JM, 2012. {Beyond checklists: using clinician prompts to achieve meaningful ICU quality improvement}. Crit Care, 16(1), Article 305.

[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.

[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.

[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.

[20]Nan S, van Gorp P, Korsten HHM, et al., 2014. Tracebook: a dynamic checklist support system. IEEE 27^th Int Symp on Computer-Based Medical Systems, p.48-51.

[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).

[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.

[23]Peleg M, 2013. Computer-interpretable clinical guidelines: a methodological review. J Biomed Inform, 46(4):744-763.

[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.

[25]Rydenfält C, Ek AA, Larsson PA, 2014. Safety checklist compliance and a false sense of safety: new directions for research. BMJ Qual Saf, 23(3):183-186.

[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.

[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.

[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.

[29]Wenzel RP, Edmond MB, 2006. Team-based prevention of catheter-related infections. N Engl J Med, 355(26): 2781-2783.

[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