CRICO Grant Spotlight: A Verbal Electronic Surgical Safety Checklist for the Intensive Care Unit

A CRICO grantee sought to develop and test the feasibility of a Clinical Assist Decision Interface

Surgical safety checklists (time-outs) are integral to promoting safety by requiring a standardized assessment of safety items prior to starting a procedure. Although proven useful, a challenge is that safety checklists can become tedious to perform repeatedly. With the technical advances in electronic health records (EHRs) and informatics, a question—which this CRICO grant-funded project sought to research—was whether software can improve the surgical safety checklist.

Project lead Raul Uppot, MD’s objectives were to:

1. design and develop a verbal electronic surgical safety checklist (a clinical assist decision interface, or CADI) specific to the needs of the Surgical Intensive Care Unit (SICU); and
2. to assess its impact on workflow and patient safety.

CADI pulls clinical information from the EHR and verbalizes it for procedure time-outs in the SICU. Overall, this project showed that a verbal electronic checklist could accurately verbalize information needed for a SICU time-out and could deliver objective information from the EHR at the point of care.

During this study, Dr. Uppot witnessed a thoracentesis in the SICU prior to which the surgical team performed the time-out using CADI. When CADI inquired about any anticoagulation medications, the team realized that heparin was still running (i.e., was not stopped). Without CADI, this issue may have been overlooked and, potentially, caused a hemothorax.

Key lessons learned during this study include:

1. identifying the appropriate project stakeholders in advance (key players to complete a task are not always the senior leaders, but frontline trainees and nurses); and
2. the importance of researching and accepting organizational IT security requirements.

For additional information: Contact Dr. Raul Uppot at [email protected]