Exploring Design Opportunities for a Context-Adaptive Medical Checklist Through Technology Probe Approach

Abstract

This paper explores the workflow and use of an interactive medical checklist for trauma resuscitation—an emerging technology developed for trauma team leaders to support decision making and task coordination among team members. We used a technology probe approach and ethnographic methods, including video review, interviews, and content analysis of checklist logs, to examine how team leaders use the checklist probe during live resuscitations. We found that team leaders of various experience levels use the technology differently. Some leaders frequently glance at the checklist and take notes during task performance, while others place the checklist on a stand and only interact with the checklist when checking items. We compared checklist timestamps to task activities and found that most items are checked off after tasks are performed. We conclude by discussing design implications and new design opportunities for a future dynamic, adaptive checklist.

Comparing the Effects of Paper and Digital Checklists on Team Performance in Time-Critical Work

“…Medical researchers at our study site have previously compared team performance during pediatric trauma resuscitations with and without paper-based checklists [15], observing improvement in the completion of some tasks, as well as increased odds of task completion in the post-checklist implementation period. In a later study, [21] we suggested that the digital checklist for trauma resuscitation could be an effective replacement for the paper form after deploying and evaluating the digital aid through a technology probe approach. Here, we build on this prior work by comparing the effects of two checklist formats on timecritical team performance.…”

“…Checklists and other cognitive aids have also caught up with this digitization trend in healthcare [1,7,21,29,33,35]. Checklists are different from EHRs because they support compliance with standardized protocols rather than just documentation.…”

“…Checklists are different from EHRs because they support compliance with standardized protocols rather than just documentation. Prior studies have shown that replacing paper forms with electronic checklist systems in medical contexts has had positive effects on task performance and teamwork [1,7,21,29,33,35,37]. Agarwala et al [1], for example, found that an electronic checklist for anesthesia handoffs improved relay and retention of critical patient information.…”

“…Although helpful, the paper checklist is static, rigid, and often incomplete, providing limited support for dynamic, rapidly evolving medical scenarios [10]. As an initial step, we converted the paper checklist into its digital counterpart (Figure 1(right)) and deployed it during actual resuscitations in a supervised manner after a period of testing with physicians [16,[19][20][21]. These initial trials have suggested that the digital checklist could be a replacement for the paper checklist.…”

“…The research assistant would stand by in case the leader had any questions or issues with the digital checklist. Using this approach, we collected feedback from an additional 11 resuscitations [21].…”