This summer, Johns Hopkins Medicine in Baltimore plans to test an ambitious new application for tablet devices that its developers hope will significantly enhance its clinicians' use of patient checklists to avoid preventable medical errors.
The Emerge app consolidates and automates checklists associated with seven patient-safety events, including blood clots and central-line associated bloodstream infections, into one centralized database. When a physician pulls up a patient's chart on a tablet or monitor, a display shows the seven potential harms. Physicians can click on them to see a clock-like display. Items in red indicate a safety concern that needs to be addressed, while green means risks have been mitigated.
For example, if patients are immobile for too long, a red light will appear showing they are at risk for a blood clot. If the daily audit of a central line has not occurred, the chart will show in red that the patient is at risk for a central-line infection.
The name Emerge comes from the concept of “emergent behavior,” meaning unanticipated behavior shown by a system. The term is used by engineers designing complex mechanical systems such as submarines, where there is zero room for error. Engineers start with the end goal—for instance that the sub won't implode under deep sea pressure—then build backward and address all the factors, or emergent behavior, that could cause that undesired event.
The Project Emerge team is applying that approach to hospital safety checklists. They start with the seven events that could imperil patient safety, then work backward to ensure that the hospital's technology and staff prevent negative outcomes. By fall, the Emerge checklist app also will be in pilot use at UCSF Medical Center in San Francisco.