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Surgery Checklist

Surgery Checklist

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Surgery Checklist is a digital version of the World Health Organization’s surgical safety checklist produced by the Therapeutic Games and Apps Lab for the U.S. Department of Veterans Affairs. It is a software suite developed in Unity for iOS and PC.

Between 1990 and 2010, approximately 600 U.S. patients died from avoidable mistakes during surgery, and about another 3,000 experienced permanent injury or disability from such mistakes. Altogether, medical malpractice suits over those 20 years associated with these preventable mistakes cost $1.3 billion dollars. [1]

The World Health Organization’s paper-based surgical safety checklist highlights the most critical parts of a typical surgery , and helps operating room teams take correct actions to prevent mistakes and problems. Correct use of the checklist significantly reduces complications and death rates. A 2008 study spanning eight hospitals in eight different cities found that inpatient complications fell from 11% to 7% following the introduction of the paper checklist. [2]

However, the paper checklist has three inherent flaws: it does not hod users accountable, it does not prevent user complacency, and it makes collaboration on the checklist within the operating room team difficult. These problems prevent the checklist from being as effective as it can be. The goal of the digital version of Surgery Checklist we created was to solve these problems.

Improving Accountability

We introduced two main features to help aid accountability for the users of surgery checklist.

QR Verification - By scanning a QR code placed on the patient’s wrist band or surgical site, Surgery Checklist can prevent wrong-patient and wrong-site surgical mistakes. If the QR code scanned before the incision does not match the QR code scanned during the pre-operation section, the checklist alerts the users that they may have the wrong patient. Additionally, the QR code can be programmed to include helpful information like the patient’s allergies and medical history.

The application also tracks the amount of time the user has spent on each checklist section. This information can be exported to administrative staff, so hospital administrators can easily track whether or not the checklist is being used appropriately. Furthermore, this feature will help hospitals better plan surgical schedules as it will automatically generate data of how long certain operations take.

Reducing Complacency:

One of the main problems we noticed with the paper checklist was that users were likely to check multiple boxes at once without paying much attention to the checklist’s contents. By nature, paper checklists must display all of the check boxes and information at once, leading users to become overwhelmed by the sheer amount of information and text on the page.
In order to help users of Surgery Checklist, we display one checklist item at a time, and only make the checkboxes for the item available while the user is focused on that item. This helps prevent important details from being missed during the checklist process.

Additionally, Surgery Checklist helps keep patient information more visible during the surgical process. The patient information panel contains information like allergy warnings that are typically only on the patient’s wristband, which is difficult to access during a surgery.

Encouraging Collaboration:

Allowing everyone on the operating room team to be involved with the checklist process is incredibly important for preventing mistakes. We created a partner application to Surgery Checklist that allows the user to connect the application to any monitor connected to a PC over a secure connection. The casting application displays the checklist in real-time, allowing all members of the OR team to be involved in the checklist process. This application is not necessary for the proper function of Surgery Checklist, allowing the application to still be useful outside of operating rooms, or in hospitals or operating rooms with outdated or broken equipment.

The structure of the surgery checklist

The structure of the surgery checklist

My Role:

I served as a producer and designer for this application over the course of 3 semesters while working at the GApp Lab. This included the initial design and development phase of the project. My responsibilities included preparing and leading meetings with stakeholders, designing the look and feel of the application, creating art assets and UI elements for the application, and planning and coordinating tasks for the two engineers working on the project. I also led our team in Unversity of Utah’s Bench to Bedside competition.

[1] O’Connor et al: Surgical Checklists: The human factor. Patient Safety in Surgery 2013 7:14
[2] A Surgical Safety Checklist To Reduce Morbidity and Mortality in a Global Population | Nejm, https://www.nejm.org/doi/full/10.1056/NEJMsa0810119

Hocus Potions

Hocus Potions