The present innovation finds particular application in medical checklist generation systems. However, it will be appreciated that the described techniques may also find application in other checklist generation systems, other medical scenarios, or other workflow improvement techniques.
Quality and safety are becoming more and more a priority for organizations. High-reliability organizations, such as aviation, navy, nuclear power and product manufacturing, are constantly improving their safety and set an example for high risk organizations. A distinction can be made between errors of commission and errors of omission. The latter are the most dangerous, because their effects are not directly visible but can have major consequences. Systematic errors can be reprogrammed, but human errors require behavioral adjustments or adjustments to the current workflow.
A checklist can be a very powerful tool to support safety by aiding the human decision making process. In aviation pilots have extensive checklist experience and the usage of checklist is embedded in the pilot's routine. In other domains, such as healthcare, checklists are implemented; however, conventional approaches attempt to provide additional safety at the cost of productivity.
Currently there exists no methodology for developing optimal safety checklists while maintaining or improving productivity and workflow throughput. Conventional checklists are created by trial and error, which results in checklists that are not effective in improving safety while maintaining or improving throughput. Possible risks associated with using these checklists include “checklist fatigue” and disruption of the user's judgment process, which can lead to injury, unsafe situations, frustration, decreased motivation and even refusal of checklist usage, interrupted workflow, and as well as increased resource and time consumption.
The present application relates to new and improved systems and methods that facilitate generating customized workflow checklists as a function of user provided rating information, which overcome the above-referenced problems and others.
In accordance with one aspect, a system that facilitates generating checklists for medical workflows comprises a computer-readable medium that stores a plurality of medical workflows and adherent tasks, and one or more workflow checklist templates, a user interface, and a processor configured to receive input related to a selected medical workflow, receive occurrence rating input related to a likelihood of an occurrence of user omission of each task in the workflow, and receive severity rating input related to a severity of potential harm to a patient due to omission of each task from the workflow. The processor is further configured to populate a workflow checklist template with tasks adherent to the selected medical workflow as a function of the occurrence rating and the severity rating for each task, insert at least one pause point into the checklist, wherein the user is prompted to interface with the checklist during execution of the workflow at the at least one inserted pause point, and output via the user interface a populated checklist with the at least one inserted pause point.
According to another aspect, a method of generating checklists for medical workflows comprises receiving input related to a selected medical workflow, receiving occurrence rating input related to a likelihood of an occurrence of user omission of each task in the workflow, and receiving severity rating input related to a severity of potential harm to a patient due to omission of each task from the workflow. The method further comprises populating a workflow checklist template with tasks adherent to the selected medical workflow as a function of the occurrence rating and the severity rating for each task, and inserting at least one pause point into the checklist, wherein the user is prompted to interface with the checklist during execution of the workflow at the at least one inserted pause point. The populated checklist is output on a user interface with the at least one inserted pause point.
One advantage is that safety is improved.
Another advantage is that worker efficiency is improved.
Still further advantages of the subject innovation will be appreciated by those of ordinary skill in the art upon reading and understanding the following detailed description.
The innovation may take form in various components and arrangements of components, and in various steps and arrangements of steps. The drawings are only for purposes of illustrating various aspects and are not to be construed as limiting the invention.
The subject innovation overcomes the aforementioned problems by offering a system that assists a user in finding an optimal balance between safety and productivity when creating a safety checklist that reduces error by omission. More specifically, the system provides a framework for the user to select situation workflows and adherent tasks for which a checklist is to be created, a reliable and easy to use method and framework for the user to prioritize and select the tasks, a framework for the user to determine when the items should be brought under attention without disrupting the workflow, and a clear and intuitive appearance for the user for the eventual utilization of the checklists. Generation of the optimized checklist comprises preparation and selection of a workflow, prioritizing and selection of tasks adherent to the workflow, assigning of tasks to pause points, and presentation of the checklist. The innovation can be used in contexts of safety-critical operations e.g. aviation, medicine, manufacturing, military, nuclear power, etc. The innovation can be implemented, e.g., as software on a PC, network service, mobile device, etc.
The memory may be a computer-readable medium on which a control program is stored, such as a disk, hard drive, or the like. Common forms of non-transitory computer-readable media include, for example, floppy disks, flexible disks, hard disks, magnetic tape, or any other magnetic storage medium, CD-ROM, DVD, or any other optical medium, RAM, ROM, PROM, EPROM, FLASH-EPROM, variants thereof, other memory chip or cartridge, or any other tangible medium from which the processor can read and execute. In this context, the systems described herein may be implemented on or as one or more general purpose computers, special purpose computer(s), a programmed microprocessor or microcontroller and peripheral integrated circuit elements, an ASIC or other integrated circuit, a digital signal processor, a hardwired electronic or logic circuit such as a discrete element circuit, a programmable logic device such as a PLD, PLA, FPGA, Graphical card CPU (GPU), or PAL, or the like.
One or more situation workflows and adherent tasks 18 are stored in memory 14. A “situation” as used herein denotes a workflow that includes a plurality of tasks and/or procedures to be performed. “Procedure” as used herein denotes a task or tasks that are to be performed sequentially and/or without interruption (e.g., without prompting the user to interface with the checklist during performance of the task(s)). In one embodiment, pause points may be inserted into the checklist at either end of a procedure but not in the middle thereof.
A user selects a situation workflow 18 (e.g. “thorax drain placement”, “intubate patient”, etc.) via the user interface 16, and selects how to import the tasks adherent to the selected workflow (e.g. import tasks from a protocol or database, enter tasks manually, etc.). The selected workflow and/or adherent tasks 18 are then loaded into a checklist template 20 that is also stored in the memory 14. The user is then prompted to provide “occurrence” rating input or information 22 via the user interface 16. The occurrence information includes the likelihood or probability that one or more tasks in the workflow could be forgotten or omitted by the user before, during, and/or after execution of the workflow. Additionally, the user is prompted to provide “severity” rating input or information 24, which includes input related to the magnitude of risk or danger posed to the patient should one or more of the tasks be forgotten or omitted before, during, and/or after execution of the workflow.
The user is then prompted to provide “check moment” input 26 indicating whether a given task may be checked or evaluated after performance (evaluation tasks) because omission of the task does not pose immediate danger to the patient, or whether the task requires a reminder prior to performance (reminder tasks) because omission of the task poses immediate danger to the patient. The processor executes a pause point module 28 that inserts pause points into the populated checklist template as a function of the check moment information provided by the user wherein the tasks adherent to the workflow are associated to pause points in a manner that ensures that the user will not be interrupted during a procedure, will be reminded ahead of time to perform tasks that may pose a risk of immediate danger to the patient if omitted, and will be prompted to evaluate or check off upon completion tasks that do not pose a risk of immediate danger to the patient if omitted. A finalized checklist 30 is then presented to the user via the user interface for use during execution of the workflow. The finalized checklist includes the tasks adherent to the selected situation workflow as well as pause points inserted into the checklist at appropriate points to prompt the user to interface with the checklist without interrupting the user unnecessarily.
With continued reference to
At 50, a user indicates or selects a situation workflow and adherent tasks for which he/she would like to create a checklist. The workflows and tasks can be predefined by the system (e.g. based on protocols and guidelines, etc.), predefined by a separate expert group (e.g. based on focus groups, discussions and observations, etc.), and/or manually entered by the user (e.g. based on the user's knowledge/experience/opinion/observations). For each task, an indication is provided regarding whether the task is to be performed before, during, or after the actual procedure and/or before or after certain pause points. The predefined information is stored in the memory. The user can load data from the memory, make adjustments, and/or save changes or add new input.
At 52, tasks within the selected situation workflow are selected and prioritized. For instance, user input can be provided to rate the tasks. Based on this input the processor ranks and prioritizes the tasks. Predefined and/or user defined thresholds and/or conditions can be used to determine which tasks are important enough to appear on the final checklist. For each task, two aspects may be rated by the user. Firstly, “occurrence” is rated, which represents the likelihood of the user forgetting to perform a task in the workflow. Secondly, “severity” is rated, which represents the risk or potential danger that arises when an item is forgotten. The occurrence and severity ratings can be descriptive or numerical, qualitative or quantitative, and/or based on obtained data or user estimations. Examples of several kinds of ratings include but are not limited to: a 1 to 10 scale; daily, weekly, monthly, annually; 1/1000, 1/500, 1/200, 1/100, 1/50, 1/20, 1/10; almost certain, very high, high, moderately high, moderate, low, very low, remote, very remote, almost impossible; etc. Thresholds and optimization conditions for task selection can depend on one or both of the rated aspects. Additional conditions can be used for one task. Example criteria for including a task on the final checklist can be, without limitation: Occurrence (rate1-10)*Severity (rate1-10)≧25; Occurrence (rate1-4)+Severity (rate1-10)≧4; Severity (rate1-10)≧9; Occurrence (descriptive scale)=(daily or weekly); etc. In the present example, two aspects (severity and occurrence) are used. More aspects can be used if desired.
In one embodiment, the occurrence rating is compared to a predetermined occurrence threshold, and if above the threshold, the task is included in the checklist. Similarly, the severity rating can be compared to a predetermined severity threshold. If the severity rating is above the threshold, the task is included. Tasks with ratings below both thresholds may be omitted from the checklist.
At 54, tasks are assigned to pause points. It may not be desirable to use a checklist during an actual procedure(s), because the workflow may be interrupted. An actual procedure can be seen as a sequence of tasks that are desired to be performed in direct sequence and without interruption, and for which postponing any of the sequential tasks has negative consequences for the workflow or process outcome, e.g. injury/damage, time delay, task repetition, additional resource usage; etc. Therefore, the system knows for each situation when the user has time to use the checklist. These moments are indicated as “pause points”. Knowledge of pause point positions in the checklist for a given protocol can be predefined or manually input. In order to determine when a pause point can be implemented, the workflow is analyzed.
At 56, the finalized checklist is presented to a user. In the presentation of the final checklist, the system indicates the following items to the user (written or visual indication). First, a distinction is made between moments when items should be checked by or pointed out to the user, e.g. using a title “PAUSE POINT 1” vs. “PAUSE POINT 2,” or placing task in different frames or boxes on the checklist, among other possibilities. Second, a distinction is made between items that serve as a reminder and items that serve as an evaluation, e.g. by providing a (actual or look-alike) check-off provision or a reminder symbol, or by displaying, e.g., “BLOODPRESSURE . . . MEASURED” vs. “BLOODPRESSURE . . . MEASURE”, etc. Third, a clear indication is provided of the CHALLENGE(subject) and according RESPONSE(verb), e.g. RESERVOIR and FILLED (or FILL). This indication can be used for the checklist title (e.g., the workflow title), as well as for the individual tasks.
It will be appreciated that the system or part of the system can be used by a single user or multiple users. Input from multiple users can be used in order to create one checklist. This input can be combined, for instance: automatically by the system, e.g. by calculating an average of the user-provided ranks, including a task if at least one person has ranked the severity(rate1-10)≧9; via automatic visualization of the input as means for discussion, for example wherein the users ranked the task individually, the system shows the average or combined input (in a graph, box plot, list, etc.,), and the users obtain the ability to discuss and reach consensus for creating one checklist; or manually wherein the users first discuss and insert only the scores they have agreed upon into the system.
In the example shown in
In one embodiment, during execution of the workflow, the user of the checklist can be required to acknowledge each reminder task (e.g. by clicking on or otherwise acknowledging the reminder task) prior to its performance and/or to verify completion of these tasks before proceeding through the checklist, in order to ensure patient safety.
The innovation has been described with reference to several embodiments. Modifications and alterations may occur to others upon reading and understanding the preceding detailed description. It is intended that the innovation be construed as including all such modifications and alterations insofar as they come within the scope of the appended claims or the equivalents thereof.
Number | Date | Country | |
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61804296 | Mar 2013 | US |