the$role$of$electronic$checklists$$ … · oral%presentaon%atmie2012,%pisa–italy% %...
TRANSCRIPT
Oral presenta+on at MIE2012, PISA–Italy
The Role of Electronic Checklists -‐ Case Study on MRI Safety
A Landmark, MB Selnes, E Larsen, A Svensli, L Solum & B. Bra8heim
The Norwegian EHR Research Center (NSEP), Norwegian University of Science and Technology (NTNU),
Trondheim, NORWAY
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Background
Trondheim, Norway Spring 2011
• Bachelor in Radiography • Group of 4 students doing their Bachelor thesis Mo?va?on: Experiences from prac+cal studies: -‐ noncompliant use of MRI safety checklist?
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Background: Why MRI safety checklist
Purpose: To ensure pa+ent safety Checkpoints: • Contraindica+ons • Informa+on about the pa+ent Rou?ne: The checklist is • Filled in during the referral process and reviewed prior to the MRI exam
MRI Pa+ent checklist-‐ paper version
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MRI Pa+ent checklist -‐ the electronic version: available through the radiological IS
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Research aim: Gain more insights into how checklists contribute to a safer health care
• How is the checklist used? • How is checklist noncompliance handled?
Context: Example case: Breast cancer diagnos+c clinic offering a triple diagnos+c model and one MRI centre (same hospital) IT infrastructure: • PACS/RIS (shared between mul+ple public hospitals within one specific health region) • Electronic Pa+ent Record (EPR), standalone with web-‐based PACS solu+on
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Method: -‐ 6 interviews of key healthcare personell -‐ 18 observa+ons of pre-‐exam review of checklists, MRI centre
The principle informa+on flow 7
Summary of main findings: How is the MRI safety checklist used?
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Summary of main findings cont:
What checklist flaws occur? • Incomplete informa+on: e.g notes about implant without type
and loca+on • Imprecise informa+on: e.g. «priority field» filled in with «no
known» • Missing informa+on: e.g
-‐ bloodtest results due to lack of intra-‐ hospital coordina+on
-‐ missing checklist for pa+ents referred from external hospitals
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Summary of main findings:
How do the actors deal with these flaws? • Cancelling the MRI exam e.g. the checklist lacked info about pacemaker
• Performing the MRI exam anyway: even if lab values of importance were lacking • Filling in the checklist anyway: even if the doctor haven’t seen the pa+ent referred from external hospitals
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While check lists offer different support for different roles: A#en&on to this mul&plicity of concerns is some&mes lost when going electronic This turn towards stop-‐control impedes poten+al dimensions of such as being an aid for trans-‐organiza+onal learning and communica+on. A balance between the check-‐list as memory aid and stop-‐control is necessary to unleash the poten+al of ICT as an enabler for improved pa+ent (and provider) safety.
Key Learning Points:
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