Medical expert Atul Gawande helped popularize the concept of a patient safety checklist with his 2009 book The Checklist Manifesto. The original concept was first applied to surgery to ensure that the operating team properly went through all safety steps before, during and after surgery. The steps include confirming a patient’s name and checking that all surgical tools have been removed from a patient’s body.
The World Health Organization and Harvard School of Public Health have developed a 19-item surgical checklist that many hospitals around the world use.
But according to WHO data, just 25% of U.S. hospitals actually use checklists, and some of those hospitals have done so hastily and without an overlying strategy for patient safety. A study published in March in the New England Journal of Medicine found that checklists may do little to reduce patient mortality and surgery complications, despite prior evidence to the contrary. As a result, researchers are looking for more efficient ways to use checklists.
Details of Johns Hopkins’ Program
The Johns Hopkins program — called Emerge — was developed by a team of patients, nurses, physicians, engineers, data analytics experts and bioethicists who identified 200 potential patient harms. The group narrowed the list to seven harms:
- Delirium due to improper medication dosage;
- Weakness acquired in the ICU;
- Issues arising from ventilator use;
- Blood clots;
- Central-line associated bloodstream infections;
- Loss of dignity; and
- Patients’ treatment goals and preferences not being respected.
When a physician pulls up a patient’s health record through the EHR system, the database shows the seven potential harms in a clock-like display. A potential harm appearing in red indicates that there is a safety concern that needs to be addressed, while green means there is no risk.
For instance, a red light might appear for “blood clot” if a patient has not been moved for a long period of time.
Peter Pronovost, director of the Armstrong Institute for Patient Safety and Quality at Johns Hopkins, said patients who are hospitalized can be exposed to harm at different points of care. He added that by evaluating multiple safety issues on one screen, staff can more easily be informed about risks that might arise.
The Emerge pilot will launch at Johns Hopkins in Baltimore and is expected to be expanded to the University of California-San Francisco Medical Center this fall (Rice, Modern Healthcare, 6/21).
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