Study On The Smart Safety Checklist In Medicine

With the rapid development of medicine and clinical techniques,an increasing amount of incurable diseases are conquered in recent years.As a sharp contrast,the unintended harm to patients,which is caused by ignorance and deviation to the best practice due to the complexity of modern healthcare,becomes a major concern in the medical domain.In response to this challenge,the safety checklist is invented to serve as a cognitive assistant tool to check critical and error-prone clinical processes and activities.Limited by its rigid form,the content in a checklist is difficult to be adapted to specific patients;and whether using a checklist or not entirely depends on users' willingness due to the lack of active integration with the clinical workflow.These limitations lead to low acceptance and adherence and hinder the wide adoption of checklists.It is an urgent requirement to have a patient-specific and context-aware checklist to overcome the problems.Using clinical decision support system and workflow management systems would be helpful to reach this goal.However,content-wise,safety checklist is a combination of clinical workflow knowledge,medical protocols,and safety check activities.None of the aforementioned systems can represent or execute the safety checklist knowledge per se.To address this issue,this study proposed a context-aware and patient-specific smart check-list and a supporting system.A three-tier knowledge representation mechanism was developed to capture the comprehensive checklist knowledge.A dynamic checklist generating technique was developed to synthesize checklists based on patient context and process context on the fly.This methodology has been implemented and tested in two clinical sites.The results show that the smart checklist can increase the adherence to the best practice and reduce medical errors while improving acceptance to checklists.Details of the thesis are as follows.1.A literature review was carried out to reveal the state-of-the-art and trend of safety checklists.The literature review surveyed the functionalities and applications of both the paper-based check-lists and computerized checklists.Furthermore,by analyzing the advantages and shortcomings of existing checklists,the concept of the smart checklist and its functional model were proposed.2.For the purpose of developing computer-interpreted checklists,knowledge representation is studied.Based on the analysis of the representation requirements,we analyzed relevant knowledge representation techniques used in business process management and decision support,decomposed smart checklist into clinical processes,clinical rules and content of checklists.A three-tier mod-el was developed to capture the knowledge.By using the proposed smart checklist knowledge representation technique,256 smart checklists for 9 clinical applications were developed.3.To execute and implement the smart checklists,an approach to developing smart checklist system has been proposed.In this chapter,we elicited the goal of smart checklist system,imple-mented clinical process execution with workflow management technology and implemented clini-cal rule execution with rule-based reasoning.A smart checklist generating engine was designed to synthetic the content of checklist from the execution result of workflow and rules.A smart checklist system has been developed to validate the feasibility of the approach.4.A case study on ICU round smart checklist was carried out to evaluate the effectiveness and feasibility of using smart checklists for complicated clinical scenarios.An ICU round checklist and supporting system were developed in a Dutch tertiary hospital.A simulation-based clinical trial was designed and organized.The results show that comparing with paper-based checklists;the smart checklist can improve the adherence to best practice while doing the round,reducing medication errors significantly.The users were satisfied with the smart checklist.5.Another case study on PCI peri-operative care was carried out to validate the feasibility of using smart checklists for complex clinical processes.A PCI-peri operative checklist set was developed in a Chinese tier-three hospital.Semi-structured interviews were carried out to validate the subjective effectiveness of smart checklists in error prevention and teamwork.The caregivers claim smart checklist can help them to detect mishaps happened in the PCI peri-operative care process and improve communication between caregivers.6.Finally,this dissertation made a general discussion and generalized the approach of develop-ing smart checklists and supporting systems.The experiences and lessons were summarized out of the two case studies.Key components of technology for building general smart checklist systems were also synthesized.