The Effect of an Electronic Checklist on Critical Care Provider Workload, Errors, and Performance.
OBJECTIVE
The strategy used to improve effective checklist use in intensive care unit (ICU) setting is essential for checklist success. This study aimed to test the hypothesis that an electronic checklist could reduce ICU provider workload, errors, and time to checklist completion, as compared to a paper checklist.


METHODS
This was a simulation-based study conducted at an academic tertiary hospital. All participants completed checklists for 6 ICU patients: 3 using an electronic checklist and 3 using an identical paper checklist. In both scenarios, participants had full access to the existing electronic medical record system. The outcomes measured were workload (defined using the National Aeronautics and Space Association task load index [NASA-TLX]), the number of checklist errors, and time to checklist completion. Two independent clinician reviewers, blinded to participant results, served as the reference standard for checklist error calculation.


RESULTS
Twenty-one ICU providers participated in this study. This resulted in the generation of 63 simulated electronic checklists and 63 simulated paper checklists. The median NASA-TLX score was 39 for the electronic checklist and 50 for the paper checklist (P = .005). The median number of checklist errors for the electronic checklist was 5, while the median number of checklist errors for the paper checklist was 8 (P = .003). The time to checklist completion was not significantly different between the 2 checklist formats (P = .76).


CONCLUSIONS
The electronic checklist significantly reduced provider workload and errors without any measurable difference in the amount of time required for checklist completion. This demonstrates that electronic checklists are feasible and desirable in the ICU setting.
Multidisciplinary Epidemiology and Translational Research in Intensive Care (METRIC), Mayo Clinic, Rochester, MN, USA.
Charat
C
Thongprayoon
Multidisciplinary Epidemiology and Translational Research in Intensive Care (METRIC), Mayo Clinic, Rochester, MN, USA Medical Scientist Training Program, Mayo Clinic, Rochester, MN, USA.
Andrew M
AM
Harrison
Multidisciplinary Epidemiology and Translational Research in Intensive Care (METRIC), Mayo Clinic, Rochester, MN, USA Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
John C
JC
O'Horo
Multidisciplinary Epidemiology and Translational Research in Intensive Care (METRIC), Mayo Clinic, Rochester, MN, USA Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
Ronaldo A Sevilla
RA
Berrios
Multidisciplinary Epidemiology and Translational Research in Intensive Care (METRIC), Mayo Clinic, Rochester, MN, USA Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA.
Brian W
BW
Pickering
Multidisciplinary Epidemiology and Translational Research in Intensive Care (METRIC), Mayo Clinic, Rochester, MN, USA Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA herasevich.vitaly@mayo.edu.
Vitaly
V
Herasevich
D057189:Checklist / Q000295:instrumentation; D002983:Clinical Competence / Q000592:standards*; D003422:Critical Care / Q000458:organization & administration*; D006801:Humans; D007362:Intensive Care Units; D019300:Medical Errors / Q000517:prevention & control* / Q000706:statistics & numerical data; D010043:Outcome and Process Assessment, Health Care; D058996:Quality Improvement / Q000458:organization & administration*; D014584:User-Computer Interface; D014941:Work Simplification; D016526:Workload / Q000706:statistics & numerical data*
checklist; decision support system; electronic; electronic medical record; intensive care unit