Documentation checklists

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Checking the box for better outcomes

Mistakes are inevitable in any industry. But in healthcare, they often come with a higher price tag and significant impact. One surprisingly simple strategy that has proven effective at minimizing errors is the use of documentation checklists.

From construction to aviation to healthcare, checklists set out specific steps that can produce consistency among team members. And for patients, they ultimately lead to better outcomes.

In his book The Checklist Manifesto, Atul Gawande, MD, explored how checklists can be used to reduce errors and improve discipline in organizations. Dr. Gawande, who is a general and endocrine surgeon at Brigham and Women's Hospital, details how he successfully implemented checklists at eight hospitals around the world using a limited budget for the World Health Organization. With checklists implemented over a period of one week to one month, this effort resulted in 36 percent fewer major complications from surgery, showing just how effective a simple checklist can be.

Checklists are a necessity

As humans, we don't know what we don't know. And even existing knowledge can be applied incorrectly if our memory fails us. Checklists solve this problem by providing basic steps to complete a task that establish a standard of baseline performance for how healthcare personnel perform activities.

Checklists are also effective in crisis situations because they can be used to outline specific actions that clinicians may overlook in high-stress, volatile or complex situations, when time is of the essence.

Another bonus of using checklists, especially in healthcare, is that they create a teamwork mindset. Because healthcare delivery settings often involve a team of nurses, doctors and other clinical staff, developing team processes and checklists can improve efficiency and overall outcomes.

Further, documentation checklists can improve workflow, ensure better patient-to-provider communication, standardize documentation, reduce risk, and potentially save clinicians time. An example of this would be a telehealth company that uses standardized checklists during the patient intake process, then passes along this organized information to the telemedicine doctor for review.

What makes a checklist effective?

An effective checklist has a few defining characteristics. Dr. Gawande says the best checklist should be:
• Short (5-9 items),
• Effective,
• To the point,
• Simple (can be used in difficult situations),
• Practical, and
• Applied in a real-world test setting.

Many brick-and-mortar medical practices have check-in and care processes that apply these checklist principles. It makes good sense that using checklists will also improve the intake, triage, and evaluation processes for e-Health and telehealth encounters.

A documentation checklist approach can easily be implemented during the intake process of an e-Health or telemedicine encounter. Information can be obtained from a patient through a mobile device, healthcare kiosk or patient portal. For example, Health Navigator can deliver over 470 different complaint-specific templates that can be used in e-Health applications to create a patient-facing rapid medical history or a consumer health bot. The structured and coded information that is gathered from the patient can then be passed along in an organized manner for review and used by call center service representatives, nurses, and telemedicine doctors.

CDS tablet checklist HN

Source: Health Navigator 2017

Healthcare organizations are using this technology in real-world settings as clinical documentation support for nurse advice lines, telemedicine programs, and other check-in protocols.

About the author:
David Thompson, MD, FACEP is CEO and chief medical officer at Health Navigator. A part-time faculty attending in the Northwestern Memorial Hospital Emergency Department, Dr. Thompson also works as an author and partner with Self Care Decisions, LLC and Schmitt-Thompson Clinical Content, LLC. In a collaboration with well-known pediatrician Dr. Barton Schmitt, Dr. Thompson has developed a comprehensive set of telephone triage protocols that are used in medical call centers and doctors' offices in the United States and internationally. He is board-certified in both internal medicine and emergency medicine, having completed a dual residency at Northwestern Memorial Hospital at Northwestern University. Dr. Thompson is a Fellow in the American College of Emergency Physicians. He can be reached at

The views, opinions and positions expressed within these guest posts are those of the author alone and do not represent those of Becker's Hospital Review/Becker's Healthcare. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them.

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