Computers Are Not Mystical Beings: The Importance of Critical Thinking
February 15, 2017 | Strategic Insights for Health System
While computerized checklists have led to significant improvements in patient care outcomes, providers may tend to "check every box," leading to potential complications, according to a February 2017 spotlight case published on the Agency for Healthcare Research and Quality's (AHRQ) Patient Safety Network. In the case presented, a 55-year old woman had been given low-molecular-weight heparin (LMWH) for venous thromboembolism (VTE) prophylaxis, even though she had a subdural hematoma. The woman died 10 days after admission, and a review found that the administration of LMWH was a medical error that may have contributed to her death. The admitting provider said afterward that she had not intended to prescribe the LMWH, in light of the subdural hematoma, and was simply "clicking boxes" on the order set in the electronic health record, because almost all patients she admitted met criteria for VTE prophylaxis. The case highlights one way checklists in healthcare differ from those used in the aviation industry, where the practice originated. While all boxes in a preflight checklist must be checked, each human patient is unique and other conditions may be present; thus, depending on the checklist and the patient, all boxes only might need to be checked. In a study of chemotherapy orders (described in a commentary to the case), the rate of problematic orders fell from 30.6% when handwritten paper orders were used to 2.2% when computerized provider order entry (CPOE) order sets were used.