Hospital operating rooms are both the site of life-saving and life-enhancing surgical procedures, as well as being the site of many preventable human errors committed in the course of patient treatment. These errors have many causes, including miscommunications among the involved personnel, inattention to important safety protocols, lack of proper information such as patient-specific information, and so forth. Various studies report the observed causes of some of these errors, and efforts to reduce the error rate. Still, significant errors occur at greater than desired rates.
One way that some hospitals seek to reduce the rate and severity of such errors, and to manage their risk of exposure to lawsuits for negligence (medical malpractice), is to require operating room personnel (e.g., nurses and/or technicians and/or physicians) to utilize checklists to remind them of actions they should take and to record that the suggested or required actions are completed. However, experience has shown that such use of checklists is far from perfect. Sometimes, an incorrect checklist is used. Other times, a checklist is not followed and actions are not taken at the intended times, but someone fills out the checklist, or a portion of the checklist, after-the-fact. This makes the answers unreliable, at least to a degree, and certainly not useful to establish an evidentiary record that correct procedures were followed. If an intended step was omitted or performed out of order, and the surgical outcome is influenced, there is no way, absent accurate records, to evaluate the situation. Moreover, individual surgeons or surgical departments often prefer protocols that differ from the “usual” procedure. Operating room personnel may make innocent mistakes because of lack of familiarity with the surgeon's standard practices that deviate from the hospital's standard practices or another department's standard practices.
Moreover, so-called best practices, and corresponding checklist content, may vary according to a patient's particulars, the latest information in medical literature or decisions by supervisory medical personnel, to give but a few reasons. Extra steps in the process are needed for the user to first confirm that the proposed checklist is, in fact, the most recent applicable checklist, and the correctness of that confirmation depends on the inquiry which is made and how much is known about the patient when the inquiry is made. For example, if there are two available checklists, one for a diabetic patient and one for a non-diabetic patient, the wrong checklist can be selected if the user has incorrect information about the patient's status with respect to diabetes. To avoid use of the wrong checklist, a comprehensive checklist covering both (and other) options may be provided. In order to cover the variations in procedure that a given patient's particulars may require (e.g., due to the patient being diabetic, allergic, obese, elderly, a child, pregnant, etc.), however, a single all-encompassing paper checklist can become lengthy and unwieldy. Including a lot of alternatives and requiring the user to make a lot of decisions about which sections to use and which sections to skip not only takes time and generates stress, but also leads to errors.
Thus, use of conventional paper checklists is not without problems and shortcomings. For example, conventional paper checklists are typically limited by the methods by which a user may indicate that a checklist item has been completed, they are limited by the ease of updating the checklist and distributing updated checklists to ensure that information contained within the checklist remains current and appropriate for the situation, and their reliability and accuracy as a data collection tool are only so good as the users' adherence to proper procedure. That is, they lack credibility as audit tools. Since it is impractical in many cases to distribute paper checklists customized to the patient, doctor, etc., comprehensive omnibus checklists are more often than not the norm, and their lack of tailored content leads to usage errors.
Furthermore, information that a user may need to determine a correct response to a conventional checklist item may not be known to the user even though a co-worker knows the information. With a paper checklist system, it may be difficult for the user to obtain this information, or to parse out portions of the checklist to other users/members of the surgical team, thus making the user's responses to checklist items potentially less accurate and less reliable.
This does not even take into account that data may be “forged” on a paper checklist. For example, a nurse, physician or technician responsible for the checklist may indicate (e.g., at the end of a surgery) that certain steps were completed that never, in fact, were executed. For a checklist to be used during a surgery time-out (when the surgery is paused to perform checks, etc.), it may be particularly important to ensure the checklist was used correctly, and used at the correct time. Failure to do so may result in an increase of risk to the patient's health and to the hospital's potential liability.
Computerized checklists may provide a way for a user to indicate that a checklist item has been completed in a more convenient manner than with a paper checklist (e.g., by checking (e.g., clicking on) a box using any one of a number of devices). However, conventional computerized checklist systems are typically nearly as limited as paper checklist systems are, in their ability to dynamically provide up-to-date information and assure the desired delivery of services and confirmation of same.