Irish Journal of Medical Science (1971 -)

, Volume 187, Issue 3, pp 553–559 | Cite as

Patient safety ward round checklist via an electronic app: implications for harm prevention

  • C. Keller
  • S. Arsenault
  • M. Lamothe
  • S. R. Bostan
  • R. O’Donnell
  • J. Harbison
  • C. P. Doherty
Original Article



Patient safety is a value at the core of modern healthcare. Though awareness in the medical community is growing, implementing systematic approaches similar to those used in other high reliability industries is proving difficult. The aim of this research was twofold, to establish a baseline for patient safety practices on routine ward rounds and to test the feasibility of implementing an electronic patient safety checklist application.


Two research teams were formed; one auditing a medical team to establish a procedural baseline of “usual care” practice and an intervention team concurrently was enforcing the implementation of the checklist. The checklist was comprised of eight standard clinical practice items. The program was conducted over a 2-week period and 1 month later, a retrospective analysis of patient charts was conducted using a global trigger tool to determine variance between the experimental groups. Finally, feedback from the physician participants was considered.


The results demonstrated a statistically significant difference on five variables of a total of 16. The auditing team observed low adherence to patient identification (0.0%), hand decontamination (5.5%), and presence of nurse on ward rounds (6.8%). Physician feedback was generally positive.


The baseline audit demonstrated significant practice bias on daily ward rounds which tended to omit several key-proven patient safety practices such as prompting hand decontamination and obtaining up to date reports from nursing staff. Results of the intervention arm demonstrate the feasibility of using the Checklist App on daily ward rounds.


Global trigger tool Harm Medical error Patient safety Population and developmental health 



We would like to thank all the patients who participated in this program and all the staff in the two medical teams who were subject to such scrutiny for over 2 weeks of the study.

Author contributions

Dr. Colin Doherty planned the study initially, before conferring with Connor Keller, Shane Arsenault, Marcel Lamothe, and Radu Bostan. The study was then led by Connor Keller and Dr. Colin Doherty, with Connor Keller, Shane Arsenault, Marcel Lamothe, and Radu Bostan conducting the study on the medical teams led by Dr. Rory O’Donnell and Dr. Joseph Harbinson at St. James’s Hospital, Dublin. The manuscript was prepared and submitted by Connor Keller, with input principally from Dr. Colin Doherty and Shane Arsenault.

Compliance with ethical standards

Competing interests

The authors declare that they have no competing interests.


  1. 1.
    Pronovost PJ, Thompson DA, Holzmueller CG, Lubomski LH, Morlock LL (2005) Defining and measuring patient safety. Crit Care Clin 21(1):1–19 vii CrossRefPubMedGoogle Scholar
  2. 2.
    Brennan TA, Leape LL, Laird NM, Herbert L, Localio R, Lawthers AG, Weiler PC, Hiatt HH (1991) Incidence of adverse events and negligence in hospitalized patients—results of the Harvard Medical Practice Study I. N Engl J Med 324:370–376CrossRefPubMedGoogle Scholar
  3. 3.
    Baker GR, Norton PG, Flintoft V, Blais R, Brown A, Cox J, O'Beirne M (2004) The Canadian Adverse Events Study: the incidence of adverse events among hospital patients in Canada. Can Med Assoc J 170(11):1678–1686CrossRefGoogle Scholar
  4. 4.
    Landrigan CP, Parry GJ, Bones CB, Hackbarth AD, Goldmann DA, Sharek PJ (2010) Temporal trends in rates of patient harm resulting from medical care. N Engl J Med 363(22):2124–2134. CrossRefPubMedGoogle Scholar
  5. 5.
    Shekelle PG, Wachter RM, Pronovost PJ et al (2013) Making healthcare safer II: an updated critical analysis of the evidence for patient safety practices. Comparative Effectiveness Review No. 211. AHRQ Publication No. 13-E001-EF. Rockville: Agency for Healthcare Research and Quality. Extensive evaluation of evidence base for patient safety practicesGoogle Scholar
  6. 6.
    Shojania KG, Duncan BW, McDonald KM et al (2001) Making healthcare safer: a critical analysis of patient safety practices, Evidence report/technology assessment No. 43, AHRQ publication No. 01-E058. Agency for Healthcare Research and Quality, RockvilleGoogle Scholar
  7. 7.
    Haynes AB, Weiser TG, Berry WR, Lipsitz SR, Breizat AH, Dellinger EP, Herbosa T, Joseph S, Kibatala PL, Lapitan MC, Merry AF, Moorthy K, Reznick RK, Taylor B, Gawande AA (2009) Safe surgery saves lives study group. A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med 360(5):491–499. CrossRefPubMedGoogle Scholar
  8. 8.
    Cabana MD, Rand CS, Powe NR, Wu AW, Wilson MH, Abboud PA, Rubin HR (1999) Why don’t physicians follow clinical practice guidelines? A framework for improvement. JAMA 282(15):1458–1465CrossRefPubMedGoogle Scholar
  9. 9.
    Shekelle PG, Pronovost PJ, Wachter RM et al (2013) The top patient safety strategies that can be encouraged for adoption now. Ann Intern Med 158(5 Pt 2):365–368CrossRefPubMedGoogle Scholar
  10. 10.
    Köstinger H, Gobber M, Grechenig T, Tappeiner B, Schramm W (2013) Developing a NFC based patient identification and ward round system for mobile devices using the android platform. Point-of-Care Healthcare Technologies (PHT) (16):176–179Google Scholar
  11. 11.
    Griffin FA, Resar RK (2009) IHI global trigger tool for measuring adverse events (second edition). IHI innovation series white paper. Institute for Healthcare Improvement, CambridgeGoogle Scholar
  12. 12.
    Taylor JA, Brownstein D, Christakis DA, Blackburn S, Strandjord TP, Klein EJ, Shafii J (2004) Use of incident reports by physicians and nurses to document medical errors in pediatric patients. Pediatrics 114:3CrossRefGoogle Scholar
  13. 13.
    Classen DC, Resar R, Griffin F, Federico F, Frankel T, Kimmel N, Whittington JC, Frankel A, Seger A, James A (2011) “Global Trigger Tool” shows that adverse events in hospitals may be ten times greater than previously measured. Health Aff 30(4):581–589CrossRefGoogle Scholar
  14. 14.
    Thomassen Ø, Storesund A, Søfteland E, Brattebø G (2014) The effects of safety checklists in medicine: a systematic review. Acta Anaesthesiol Scand 58(1):5–18. CrossRefPubMedGoogle Scholar
  15. 15.
    Taylor SL, Dy S, Foy R et al (2011) What context features might be important determinants of the effectiveness of patient safety practice interventions? BMJ Qual Saf 20(7):611–617CrossRefPubMedGoogle Scholar

Copyright information

© Royal Academy of Medicine in Ireland 2017

Authors and Affiliations

  1. 1.Trinity College DublinDublinIreland
  2. 2.Department of Respiratory MedicineSt James’s HospitalDublinIreland

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