Healthcare Checklist Research Articles

Design Approaches for Developing Quality Checklists in Healthcare Organizations: A Scoping Review.

Quality checklists have demonstrated benefits in healthcare and other high-reliability organizations, but there remains a gap in the understanding of design approaches and levels of stakeholder engagement in the development of these quality checklists. This scoping review aims to synthesize the current knowledge base regarding the use of various design approaches for developing quality checklists in healthcare. Secondary objectives are to explore theoretical frameworks, design principles, stakeholder involvement and engagement, and characteristics of the design methods used for developing quality checklists. The review followed the Preferred Reporting Items for Systematic Reviews 2020 checklist. Seven databases (PubMed, APA PsycInfo, CINAHL, Embase, Scopus, ACM Digital Library, and IEEE Xplore) were searched for studies using a comprehensive search strategy developed in collaboration with a health sciences librarian. Search terms included "checklist" and "user-centered design" and their related terms. The IAP2 Spectrum of Participation Framework was used to categorize studies by level of stakeholder engagement during data extraction. Twenty-nine studies met the inclusion criteria for this review. Twenty-three distinct design methods were identified that were predominantly non-collaborative in nature (e.g., interviews, surveys, and other methods that involved only one researcher and one participant at a given time). Analysis of the levels of stakeholder engagement revealed a gap in studies that empowered their stakeholders in the quality checklist design process. Highly effective, clear, and standardized methodology are needed for the design of quality checklists. Future work needs to explore how stakeholders can be empowered in the design process, and how different levels of stakeholder engagement might impact implementation outcomes.

Dental Monitoring Application of Simogi to Change Parental Behavior for Maintaining Children Dental Health

Children's oral and dental health needs to be maintained from an early age in order to sustain the integrity of their teeth. A new dental health care monitoring named SIMOGI (Dental Health Monitoring System) application is proposed. This application is used by parents and it’s integrated with dental therapist’s account. The application has features of dental health care checklist and dental danger sign. The aim of this study is to analyze changes in parental behavior towards the maintenance of children's oral health with the implementation of SIMOGI. This research is an experimental study with pretest and posttest design with control group design. The total sample used is 20 parents of elementary school in grade 3. A behavioral questionnaire on dental and oral health maintenance on knowledge, attitudes and actions were done to measure the effect changes. The category is grouped into bad, fair and good. This experiment ran for 21 days. The analytical test used is univariate analysis, bivariate analysis using the Wilcoxon test. The results show that in knowledge, there is no effect on control (p-value 1.000) and intervention group (p-value 0.785). There is effect on intervention group’s attitude (p-value 0.018) and no effect on control group (p-value 0.317). There is effect both in intervention (p-value 0.024) and control group (p-value 0.102). There is an effect of using the SIMOGI application on changes in parents' attitudes and actions in maintaining children's dental health. Knowledge of the parents is already in the good category.

High risk delivery checklists: Evaluating stress reduction and communication

ObjectiveImprove communication and decrease stress reduction by consistent use of high-risk delivery checklists. BackgroundCommunication has shown to decrease the risk of sentinel events. Limited knowledge exists on the use of high-risk delivery checklists and its effect on stress and communication. MethodsQualitative methods were used to measure whether communication improved with checklists using a triangulation process. Quantitative methods were used to measure stress related to high-risk deliveries for nurses who were new to the delivery team using pre and post surveys over a three-month period. ResultsResults showed no statistical significance in stress reduction, though several themes were identified for communication while using the checklists. Lack of participation was a major determinant of the study. ConclusionImprovement in communication and stress reduction was identified as stated by participants in the study. Continued research is needed on the impact of checklists in healthcare.

Checklists in Healthcare: Operational Improvement of Standards using Safety Engineering - Project CHOISSE — A framework for evaluating the effects of checklists on surgical team culture

The CHOISSE multi-stage framework for evaluating the effects of electronic checklist applications (e-checklists) on surgical team members' perception of their roles, performance, communication, and understanding of checklists is introduced via a pilot study. A prospective interventional cohort study design was piloted to assess the effectiveness of the framework and the sociotechnical effects of the e-checklist. A Delphi process was used to design the stages of the framework based on literature and expert consensus. The CHOISSE framework was applied to guide the implementation and evaluation of e-checklists on team culture for ten pilot teams across the US over a 24-week period. The pilot results revealed more engagement by surgeons than non-surgeons, and significant increases in surgeons’ perception of communication and engagement during surgery with a small sample. Mixed methods analysis of the data and lessons learned were used to identify iterative improvements to the CHOISSE framework and to inform future studies.

Barriers to healthcare and their relationship to well-being and social support for autistic adults during COVID-19.

The present study aimed to investigate barriers to healthcare and their relationships to social and emotional well-being and intersectional inequalities for autistic adults during COVID-19 restrictions in the UK. Autistic adults experience severe health inequalities and report more barriers to accessing health services compared to other both disabled and non-disabled populations. The COVID-19 pandemic has impacted many areas of society that may have increased vulnerability of autistic people to social and health inequalities, including delivery of healthcare from in-person to remote methods. One hundred twenty-eight autistic adults who lived in the UK took part in an online survey. Measures included the Barriers to Healthcare Checklist (Short Form) and PROMIS outcome measure bank to assess emotional well-being and social support. Participants rated their agreement with items, retrospectively considering three different points of the trajectory of COVID-19 restrictions: before COVID-19, during the first lockdown in spring 2020, and in the month prior to taking the survey during autumn 2020. They completed a follow-up survey six months later to continue to assess change as restrictions in the UK were eased. The average number of barriers to healthcare showed no significant change between all four time points. However, the nature of barriers to healthcare changed at the point of lockdown and persisted beyond the easing of COVID-19 restrictions. Barriers to healthcare were associated with some social and emotional well-being variables and demographic groups including gender, education and presence of additional disabilities. The findings may help to identify areas to target to improve access to both remote and in-person health systems for autistic people as modes of delivery continue to change over time.

Psychometric testing of a set of patient-reported instruments to assess healthcare interventions for autistic adults.

Interventions to improve healthcare for autistic adults are greatly needed. To evaluate such interventions, researchers often use surveys to collect data from autistic adults (or sometimes, their supporters), but few survey measures have been tested for use with autistic adults. Our objective was to create and test a set of patient- or proxy-reported survey measures for use in studies that evaluate healthcare interventions. We used a community-based participatory research (CBPR) approach, in partnership with autistic adults, healthcare providers, and supporters. We worked together to create or adapt survey measures. Three survey measures focus on things that interventions may try to change directly: (1) how prepared patients are for visits; (2) how confident they feel in managing their health and healthcare; and (3) how well the healthcare system is making the accommodations patients feel they need. The other measures focus on the outcomes that interventions may hope to achieve: (4) improved patient-provider communication; (5) reduced barriers to care; and (6) reduced unmet healthcare needs. We then tested these measures in a survey of 244 autistic adults recruited from 12 primary care clinics in Oregon and California, USA (with 194 participating directly and 50 participating via a proxy reporter). Community partners made sure items were easy to understand and captured what was important about the underlying idea. We found the survey measures worked well in this sample. These measures may help researchers evaluate new healthcare interventions. Future research needs to assess whether interventions improve healthcare outcomes in autistic adults.

Using checklists to improve patient safety during anaesthesia

Background: It is inevitable that human errors will sometimes happen in practice, but these can be reduced by following some strict, straightforward checklists; these can serve as ‘aide-mémoires’, ‘challenge/response’ or...

Why is the Implementation of Crew Resource Management through Checklists in Healthcare not Systematically Successful? An Answer from Cognitive Systems Engineering

Why is the Implementation of Crew Resource Management through Checklists in Healthcare not Systematically Successful? An Answer from Cognitive Systems Engineering

Complex Dental Implant Cases: Algorithms, Subjectivity, and Patient Cases Along the Complexity Continuum.

Algorithms for predictable outcomes, or checklists in health care, have been widely supported due to their highly effective outcomes. This article shares "algorithmic roadmaps" to restore single-tooth, partially edentulous, and fully edentulous complex dental implant cases in the patient population. A review of the current literature is presented to provide systematic assessments followed by criteria in a checklist format that allows the surgeon and restorative dentist to determine whether a removable or fixed implant prosthesis is the best patient option. Several cases have been chosen to illustrate the algorithms the authors used to provide an optimized prognosis for surgical/restorative success.

Psychometric testing of a checklist for procedural training of peripheral intravenous insertion

BackgroundNurses, medical technologists, nuclear medicine technologists, pre-hospital providers, and medical students are a few groups of healthcare learners asked to learn intravenous (IV) cannulation in their training (J Surg Educ. 69:536–43, 2012). Despite the fact that IV cannulation has been taught to several health professions, it is difficult to find a psychometrically validated checklist to guide teaching this skill in the simulated procedural training (Pediatrics 124: 610-9, 2009, J Assoc Vasc Access 21: 196-204, 2016). In the absence of a pragmatic, valid checklist for the initial teaching of peripheral IV skills in the simulation procedural skills lab, this investigation sought to describe the process and create a psychometrically valid checklist.MethodsExpert raters used Lawshe’s method for identifying valid items from the universe of items for IV insertion. Gwet’s AC2 and generalizability (G) theory was used assess inter-rater reliability.ResultsThe literature and in-house IV checklists were examined for steps to inserting a peripheral IV, and the steps were compiled into a survey and sent to experts who rated each item. Of the 37 potential steps, 16 steps were identified as being psychometrically valid. The checklist content validity index was .82. Inter-rater reliability was .94 (95% CI .91–.98). Good inter-rater reliability was confirmed using generalizability theory.ConclusionsThis study created and provided evidence of content validity and reliability for this checklist using Lawshe’s methodology. As such, this method of evaluating a checklist for validity and reliability evidence can be followed for other healthcare checklists. This checklist can be used for teaching IV placement in healthcare students in the simulation procedural training lab.

Interdisciplinary Educational Checklist for Allogeneic Stem Cell Transplant Patients

Allogeneic hematopoietic stem cell transplant (HSCT) has emerged as a unique treatment modality. Patients who receive an allogeneic HSCT report feeling inadequately equipped to manage their postdischarge plan of care. It is essential that interdisciplinary team members prepare HSCT patients with the education needed in order to deal with the overwhelming care needs involved during and after hospital discharge. Targeted interventions that promote effective, meaningful education and behaviors are needed to guide patients and caregivers through this treatment experience together. Health-care checklists have produced dramatic, sustained gains in patient safety and quality of care. Checklists provide an ideal way to comply with standards of evidence-based care and promote good communication among interdisciplinary team members. The main purpose of this project was to investigate the use of an educational checklist for allogeneic stem cell transplant patients by interdisciplinary team members. Provider use of the educational checklist was evaluated at discharge assessing completion of checklist items.

The Prevalence and risk factors of osteoporosis among the elderly in Hamadan province: A cross sectional study.

Background: Osteoporosis is the most common metabolic bone disease and is a public health issue, particularly among the elderly, across the world. Given the significance of the disease in causing disability and, in particular, its dangers in old age, we aimed to examine osteoporosis and its determinant factors among the elderly. Methods: We conducted a cross sectional study in the province of Hamadan from September 2015 to March 2016 on all the elderly men and women covered by ‘Integrated and Comprehensive Elderly Care Program’. The data required for this study was collected through an aging health care checklist. To estimate the adjusted association of potential risk factors and other confounding variables of osteoporosis, multiple logistic regression was used at a significance level of 5%. Results: In this cross sectional study, 1779 elderly men and women aged 6o years and over were studied. The prevalence of osteoporosis was 7.99% (95%CI:7.79-8.18), which was higher among women than in men (8.08% vs. 7.83%). The factors that raised the probability of osteoporosis were as follow: aging (OR= 1.05, 95% CI: 1.02-1.07, p<0.001), low education (OR=1.96, 95% CI:1.02-3.84, p=0.04), living in urban areas (OR=2.82, 95% CI:1.93-4.11, p<0.001), smoking (OR=2.39, 95% CI:1.42-4.04, p<0.001), and family history of osteoporosis (OR=1.95, 95% CI:1.07-3.54, p=0.03). Conclusion: Based on our results, aging, low education level, living in urban areas, being a cigarette smoker, and having a family history of osteoporosis were all predicting factors for osteoporosis among the elderly.

Multifactorial Strategies for Sustaining Safe Patient Handling and Mobility.

Reduction in nursing staff injuries has occurred with the use of an evidence-based approach to safe patient handling and mobility. Parts of the evidence-based practice initiative include having the appropriate equipment, such as mechanical patient-lifting devices, a no-lift policy, and the use of peer coaches. The combination of the implementation of a culture of safety can sustain evidence-based, safe patient-handling practices that reduce patient-handling injuries. Patient-handling programs should include adaptations for an aging nursing workforce. The use of safety checklists in health care can improve communication and compliance with safe patient-handling and mobility policy and program components.

Cost-Effectiveness of Drug Treatments for Advanced Melanoma: A Systematic Literature Review.

Until recently, advanced melanoma (unresectable and metastatic) has had a poor prognosis and has been treated with chemotherapy. The introduction of new treatments (BRAF and MEK inhibitors and immunotherapy) has improved overall survival and progression-free survival of some patients. The objective of this study was to review the published evidence on the cost-effectiveness of pharmacological treatments for advanced melanoma. A systematic literature search was conducted, without date or language restrictions, in PubMed, EMBASE, Scopus, the Cochrane Library, the UK National Institute for Health and Care Excellence databases and the Health Technology Assessment journal. Internet searches were also made to identify possible grey literature. Main study characteristics, methods and outcomes were extracted and critically assessed. The quality of health economic studies was assessed by the Quality Assessment of Economic Evaluation in Health Care checklist. The search identified nine full-text pharmacoeconomic analyses of advanced melanoma treatments. According to the economic analyses published in the articles, the new treatments have been shown to be more effective (with more life-years and quality-adjusted life-years) than chemotherapy, although generally the cost per quality-adjusted life-year gained was above the commonly accepted threshold. Because of the variability of the available analyses comparing the new treatments, we cannot determine which treatment is the most cost-effective. From the available data, it cannot be concluded that the new drugs (BRAF and MEK inhibitors and immunotherapy) are cost effective compared with chemotherapy or which is the most cost-effective new treatment.

Safe behaviours and acceptance of the use of checklists in urban obstetric units in Colombia

IntroductionThe use of checklists in healthcare, has proven to be a useful means for improving safety in care and reducing errors and adverse events; however, acceptance and use by healthcare practitioners is still an important problem. ObjectiveTo describe the degree of knowledge and acceptance of the use of checklists, and to determine the percentage of safe practices performed by healthcare workers during obstetric care in obstetrics and gynaecology units in Colombia. MethodCross-sectional observational study. The sample consisted of healthcare teams of the obstetric areas in three institutions. The acceptance survey was given based on convenience sampling to 38 healthcare workers in institution A, 74 in institution B and 50 in institution C, and 29 maternal care observations were made in each institution. ResultsIt was found that healthcare workers are aware of the checklists, have used them or are using them, and show and intermediate level of favourable attitudes, institution A being the one with the most favourable attitude towards their use. The three institutions had similar percentages of compliance with safe behaviours (72–79%), but some had lower values in areas such as confirming or administering antibiotics, compliance with the hand washing protocol, and processes related to patient or family education. ConclusionsHealthcare professionals working in the obstetric units assessed had, at the time, knowledge and experience with the use of checklists and relatively good attitudes towards them; moreover, the level of compliance with safe behaviours was medium to high.

Evaluating quantifiable metrics for hospital green checklists

While hospitals, sustainable healthcare organizations, and recent peer-reviewed publications have assessed the sustainability of medical products and services, the healthcare industry lacks a framework to effectively inform environmental decision making and quantitatively assess the success of sustainability initiatives for medical products and services. Several recent publications have even expressed a need for better ways to quantify sustainable healthcare practices. To address these needs, this research compared the cradle-to-grave environmental and economic impacts of some of the most common recommendations from checklists: reusable versus disposable medical products, and changes to common medical services. Salient results and conclusions from recent studies focusing on the environmental and economic impacts of various reusable versus disposable medical products and different medical services were synthesized and prioritized. All relevant results related to environmental and economic impacts of reusable versus disposable medical products and the analyzed medical services were also correlated with existing sustainable checklists. The results showed that reusable products were less expensive their single-use disposable alternatives. The dental bur also required the least amount of water for its associated cleaning processes, had the lowest total embodied energy, and had the lowest associated greenhouse gas emissions. These outcomes were likely due to the fact the burs were, by far, the smallest examined product. Based on the results derived from the study, healthcare checklists should be updated to include: optimizing the reusability of medical products; reduce products utilized in custom packs; and evaluating energy recovery potential of utilized products. The results of this study indicate that sustainable healthcare checklists be further validated with more environmental and economic life-cycle analyses related to medical products and services. The primary aim of this paper is to assist hospital employees and administrators with making more informed decisions about the sustainability of their products and services. The scientific value of this paper is underscored by a novel aggregation of life cycle assessment studies pertaining to medical devices and services in order to draw conclusions regarding the overall sustainability of those medical devices and services.

Checklists and Other Cognitive Aids For Emergency And Routine Anesthesia Care-A Survey on the Perception of Anesthesia Providers From a Large Academic US Institution.

Background:The use of printed or electronic checklists and other cognitive aids has gained increasing interest from anesthesia providers and professional societies. While these aids are not currently considered standard of care, the perceptions of the clinician might have an impact on their adoption.Objectives:We conducted a comprehensive survey to study the current opinions of anesthesia provider on the use of checklists and other cognitive aids.Patients and Methods:A questionnaire was developed by a departmental checklist focus group, which aimed to identify the perception of health care checklists in general as well as specific checklists for routine and crisis situations in anesthesia. Furthermore participants were asked regarding their perception of performing routine anesthesia and managing crisis situations without any cognitive aids. Using a web-based system, the survey was administered to all anesthesia providers at a single large United States academic medical center (University of California San Francisco). Demographic information included professional status (faculty, anesthesia resident, or nurse anesthetists [certified registered nurse anesthetists; CRNA]) and years of clinical experience.Results:69% of 312 providers responded. 98% of the survey takers consider the procedural time-out (the widely used pre-incision operating room checklist) as important or very important. We found that many anesthesia providers acknowledged limitations in their ability to perform clinical tasks without any lapses, and a majority would use checklists and other cognitive aids if available. Their acceptances are especially high for crisis situations (87 - 97%, depending on years of experience) and routine care that providers do not perform often (76 - 91%). Printed or electronic aids for patient-care transition and shift hand-offs were also valued (61% and 58%). To prepare for and perform routine anesthesia care, 40% of providers claimed interest in using checklists, however, the interest differed significantly with clinical experience: While both the least and most experienced providers valued aids for routine anesthesia (54% and 50%), only 29% of providers with 2 - 10 years of anesthesia experience claimed interest in using them. Distraction from patient care and decreased efficiency were concerns expressed for the use of routine checklist (27% and 31%, respectively). The main factors found to support the successful implementation of checklists into clinical care are ease of use and thoughtful integration into the anesthesia workflow.Conclusions:Providers at our large academic institution generally embrace the concept of checklists and other cognitive aids. This was true for all providers for checklists for procedural time outs, anesthesia crisis situations and those for routine procedures that providers rarely perform. Only very experienced and very junior providers appreciated the use of checklists for routine care. There remains a discrepancy between these claims and provider’s perception on their clinical competency based on memory alone.

Safety checklist compliance and a false sense of safety: new directions for research

In recent years, checklists to improve patient safety have gained considerable support.1–,4 The most well-known checklist introduced for this purpose is probably the WHO surgical safety checklist.5 The WHO checklist...

Republished: Safety checklist compliance and a false sense of safety: new directions for research

In recent years, checklists to improve patient safety have gained considerable support.1–,4 The most well-known checklist introduced for this purpose is probably the WHO surgical safety checklist.5 The WHO checklist...

Turner Syndrome: Updating the Paradigm of Clinical Care

Turner syndrome (TS), in which there is loss of all or part of one sex chromosome, occurs in one in 2500 live-born females and is associated with characteristic findings. Detailed healthcare checklists and screening guidelines are commonly used to detect known complications affecting individuals with TS. Even with the use of these guidelines, there remains an increased morbidity and mortality seen in TS as compared to the general population, leading to significant controversy on optimal management of several aspects of TS. A PubMed search of articles from the past 15 yr identified available studies related to the diagnosis and management of common issues related to TS as well as important historical articles. This review summarizes studies through January 2012 and highlights recent developments. There remain many areas of uncertainty in the diagnosis and management of TS. Generalizations from experience in the care of other conditions in isolation (such as poor growth, follow-up of cardiac disease, or the treatment of ovarian failure) cannot be broadly applied when caring for individuals with TS. Specific differences include treatment of growth failure as early as possible; acquisition of adequate baseline cardiac studies, followed by serial magnetic resonance imaging, targeted to identify findings unique to TS that address the increased risk of aortic dissection; initiation of hormone replacement at the normal age of puberty, preferentially with transdermal estradiol; and detailed patient counseling to explain the long-term health risks commonly associated with this disorder. A revised paradigm of care using a standardized multidisciplinary evaluation, supplementing screening tests as advocated by expert opinion guidelines, can aid clinicians in interpreting the results of diagnostic testing in the context of TS. This approach optimizes medical care for women with TS and may reduce the increased morbidity and mortality currently seen in this population.