J. Langell1,2,3, J. Ferraro1, M. Young1, C. Mi1, Y. Deng1, C. Swensen1, J. Langell1,2,3 1University Of Utah,Center for Medical Innovation,Salt Lake City, UT, USA 2University Of Utah,Department Of Surgery,Salt Lake City, UT, USA 3VA Salt Lake City Health Care System,Center of Innovation,Salt Lake City, UT, USA
Introduction:
Preventable surgical errors occur in 3-16% of surgeries worldwide and account for >1 million deaths per year. These include wrong site surgeries, wrong procedure, wrong patient, incorrect implant and other so called “never events”. The use of surgical safety checklists (SSC) as a tool to improve surgical communication and planning have been shown to be effective in reducing preventable surgical errors in numerous research studies. Outside of monitored research studies, the effectiveness of SSC drops substantially due to provider complacency and poor compliance.
Methods:
We conducted a literature review on surgical safety checklist efficacy and compliance issues and performed observational checklist usability studies and stakeholder review sessions. Output from these reviews and studies were used as design inputs for the development of an automated, digital surgical safety application. Iterative usability testing and human factors design analysis were then performed on the completed product with input from multiple surgeons, anesthesiologist, nurses and surgical technicians.
Results:
A literature review on surgical checklists noted concerns with team engagement, checklist compliancy, lack of participation, failure to complete the entire checklist and lack of accountability and ownership. Our internal analysis demonstrated similar findings, in addition we found that many checklist items were filled out in advance, especially the post-procedure portions. Stakeholder analysis highlighted a need for 1) automation of patient identification, critical characteristics, procedure performed and operative location verification 2) a need to increase team engagement and accountability 3) prevention of user complacency and compliance errors. Data acquired through these studies were used as design inputs to produce a fully functional automated, digital surgical safety checklist application. The final product provided a user-centered design with automated patient identity feature via scannable QR code technology, provided mistake proof checklist question progression and completion, increased team engagement through large monitor projection, and increased accountability through signature capture and electronic medical record documentation. A final usability analysis of the application received uniformly positive feedback for adoption and use by all clinical team members.
Conclusion:
Current paper-based surgical safety checklists suffer from use complacency, poor compliance, low provider engagement and lack of accountability. Automated digital surgical safety checklist may provide a solution to overcome these barriers and improve the impact of surgical checklists in reducing surgical errors due to poor communication and planning.
