Latest Design Lab project: Increasing Surgical Safety Checklists’ usability and usefulness
In this study we designed an electronic Surgical Safety Checklist that projects the checklist elements on top of the patient’s surgical drape, while voice commands are used to navigate throughout the checklist. By means of our digital checklist, elements are easy to read, while the risk to forget to verify elements is lowered. The physical parts of the device are assembled by means of a 3D-printed scaffold (sketched and printed at the Design Lab), while the software was developed at the Design Lab too.
Reducing complications and deaths in operating rooms (ORs) due to human error is a big challenge for hospitals. To explain variability in surgical outcomes, studies have primarily focused on patient pathophysiological risk factors and surgeon skills . Hence, when the patient did not account for the surgical complication, the error was then attributed to the surgeon’s aptitudes and capabilities . However, more recent research shows that errors “arise not from the solitary actions of individuals but from conflicting, incomplete, or suboptimal systems .” These systems notably refer to the people involved in surgical cases as well as the tasks, tools, or technologies; environment; and organization (eg, hospitals or clinics). To analyze and improve patient safety, the US Institute of Medicine and the National Academy of Engineering have promoted the use of human factor techniques. Human factor techniques investigate factors and develop tools that facilitate the achievement of goals (eg, reduce errors, increase productivity, improve safety) . To that end, among many different initiatives, the World Health Organization (WHO) has collected scientific evidence and published guidelines to address part of the problems with safety of surgical patients . These guidelines are summarized as a 19-item checklist that aims to establish systematic verifications before anesthesia, before surgery, and after surgery . Existing research demonstrates that when systematically applied, surgical safety checklists (SSCs) can reduce complications and mortality from 19.9% to 11.5% and 1.6% to 1.0%, respectively [7,8]. However, at the expense of patient safety, SSCs have not been entirely adopted by hospitals. In the United Kingdom and France, where the use of the SSC is mandatory, the average SSC completion rate is 60% [9,10]. Such low completion rates are notably explained by the ORs constraints and bad design of the SSC implementations (eg, the checklists are often formatted by administrative staff who do not have the required skills; as a result, checklists are often difficult to read due to inappropriate fonts and colors) . This is particularly the case with the time-out checklist. Because it takes place right before surgery commences and surgeons are not supposed to leave the 30 cm (12-inch) sterile area around the surgical table , they have to rely on a poster on the OR wall, often far from their field of view . Additionally, surgeons complain that time-out checklists are not specific enough and often require them to spend time verifying irrelevant things. Finally, checklists are sometimes obsolete, and checklist completion is often not documented in the patient’s medical record. Consequently, time-out checklists often do not bring enough benefits to surgeons and, thus, are not systematically used [12,13].
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- Haugen AS, Søfteland E, Almeland SK, Sevdalis N, Vonen B, Eide GE, et al. Effect of the World Health Organization checklist on patient outcomes: a stepped wedge cluster randomized controlled trial. Ann Surg 2015 May;261(5):821-828. [doi: 1097/SLA.0000000000000716] [Medline: 24824415]
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- Russ S, Sevdalis N, Moorthy K, Mayer E, Rout S, Caris J, et al. 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 2015;261(1):81-91. [Medline: 25072435]
- Mayer E, Sevdalis N, Rout S, Caris J, Russ S, Mansell J, et al. Surgical checklist implementation project: the impact of variable WHO checklist compliance on risk-adjusted clinical outcomes after national implementation: a longitudinal study. Ann Surg 2015;263(1):58-63. [Medline: 25775063]