In hospital trauma centers, where life or death decisions are made in seconds; so fractions of a second it takes even the best doctors to remember could be pivotal. With the goal of saving time and lives, Drexel University researchers have working with doctors from Children’s National Medical Center in Washington; D.C. to create and implement the first digital procedural checklist for trauma centers.
Over the last dozen years, the humble checklist has emerge as a valuable tool in medical settings. A seminal study at Johns Hopkins in 2013 showed that using a simple checklist with basic reminders about proper hand-washing, sterilization of instruments and procedures to avoid contamination dramatically reduced infection rates associated with a common intravenous insertion procedure in intensive care units.
Trauma center could be beneficial
While it might seem intuitive that intense and dynamic setting of a trauma center could benefit from having a cognitive aid and a better way to record everything that’s going on, introducing new technology can actually be a setback at first and that’s something doctors in trauma centers just can’t afford,” Sarcevic said. “Finding that our digital checklist did not have an adverse effect on the trauma teams’ performance is an important indicator of success for our process of design and implementation.
Sarcevic first participated in the development of the checklist in paper form; so alongside co-author Randall Burd, MD, and his collaborators at Children’s National. After nearly a year of revisions, the group settled on a list that included some 55 tasks; hence from steps to prepare for the arrival of a patient; so to standard observations and checking vital signs, to more advanced examinations and tests.
Over the next three years the Drexel team observed the doctors as they began to use it in trauma settings. To date, the Drexel team had analyzed 800 cases in which trauma team leaders had used the paper checklist. Through that analysis, which included reviewing video of trauma procedures and interviewing trauma team members; hence the group tease out the essential elements of the list and began translating them into digital form.
Teams in real clinical events
The way we did it was to make a prototype and shadow teams in real clinical events. They got feedback on what parts are clunky, what team leaders want to see; also the Drexel team work out how to visualize it right down to font size and color, Burd said. They sort out a lot of those things before we put it in the hands of people in the trauma center.
The group went through 10 major design updates and more than a dozen smaller changes; hence before finalizing the checklist for full-scale testing. It was exciting to see our work be use in real trauma settings; hence to get input from the team leaders who were the first ones to use it, Kulp said. Listening to the doctors and understanding how they use the list; so both to take notes and to keep things in order really helped us to make informed design changes over time.
Burd and Sarcevic are now expanding the scope of their research to take a broader look at the functions of a trauma team. Using video, image capture and sensors, in addition to data recorded on the tablets; hence they will look for other ways to integrate guidance and support systems in hopes of improving trauma outcomes.
They see human error in medicine all the time. And the typical response is to peg it as an individual’s failure to know something or to execute something properly, Burd said. But the reality is: These are human beings in a complex system. In order to make improvements they need to do what other industries; hence have done they need good people doing the work and we need to provide them with the support to make the right decisions.