CheckAid app provides surgery checklist for the OR

App Review of “CheckAid” by “AppsOnIce, LLC”

By Joseph Sujka MD

Checklists, as evidenced by WHO, have shown to be invaluable in delivering safe and complete patient care, specifically in surgery. They are a flexible tool for surgeons, used for Timeout procedures, equipment checklists, diagnosis and treatment of patients. Most recently at my own institution we have begun using a daily checklist in our Trauma Step Down unit. This checklist reminds us to question various things every day for our patients such as, “Does this patient still need a foley? Do they have DVT prophylaxis?”

These simple daily questions prevent small things from being missed during rounds, ensuring that patients are at a decreased risk for infection and are kept on appropriate prophylaxis. Currently this checklist is maintained with laminated paper that we mark with a dry erase marker. One would think there would be better ways to organize and reuse these and other checklists in the hospital.

CheckAid, released December 18, 2013, is a checklist application that downloads standardized checklists provided by institutions. These checklists are created to fit an institution’s specific medical standards. When CheckAid first launches, a series of available checklists is presented in alphabetical order. Any checklists that have been partially completed show up in red and an icon adjacent to the list allows you to find information about that checklist.

No checklists are pre-loaded so to download a list simply press on the lower left corner ‘+’ icon to search available checklists. At time of writing the number of checklists available is very limited, only 15 checklists from Grey Base Hospital and Seattle Children’s hospital, with most geared towards Timeout procedures. This number should increase with time but given that an institution must first formulate and submit a checklist before its inclusion, the usefulness of this app will be dependent on the ability to generalize an institution’s checklists or the willingness of an institution to formulate a standardized set of checklists.

Once you open a checklist in the app, using ‘PACU Signout’ as an example, there are subtopics to check. The four categories in PACU Signout are Patient, Procedure, Anesthetic, and Post Op. Under each heading are questions to be answered about the patient after surgery. You can either tap each box to check off a task or switch to ‘Check Mode’ enabling you to tap ‘Check’ at the bottom of the screen or ‘Skip’ if you do not want to check it. A small icon along the left of the list indicates which item you will be either checking or skipping. Once all the items in a list are checked, the list is marked ‘Complete’ and is displayed as checked off in the main list. When you’re ready to reset a list simply click the circle arrow icon in the top-right to reset it.

CheckAid, while limited in content, has a great framework and could be helpful in daily resident life. It provides a responsive, quick loading, and simple to use format but is held back by many puzzling decisions. The first issue is the lack of local checklist creation. The developers state in their FAQ that they avoided local checklist creation because they wanted institutions to be able to standardize their checklists. This places an unnecessary stumbling block into the application as you cannot test checklists or even experiment locally in the application. Another major issue is the inability to share your checklists with others. You cannot assign a checklist to a patient and have others see what you have already checked off for that day. This would be a fantastic feature and allow teams to quickly see what needs to be completed or checked for a patient.

A similarly major drawback is CheckAid’s lack of procedure and diagnosis checklists. These have not been created by others and with CheckAid having been released almost one year ago it’s discouraging to see such a small amount of available checklists. At this time there really are no easily generalized checklists that you can download and use immediately. They are all very specific to their respective institutions. To make CheckAid useful you would have to be invested in it and develop all your own checklists from scratch. If the diversity of checklists increases, CheckAid could blossom into an application that is significantly more useful.

The disappointing thing about CheckAid is that, despite these flaws, it has a great framework. I could easily see this tool used on rounds to make sure that a surgery team is up to date on what has been completed for a patient’s daily management or as a means of making sure a procedure is performed appropriately.

I don’t see the utility of using this application for Timeouts as surgeons will either be scrubbed and therefore unable to access their phone or will have a nurse available who performs the Timeout. With future expansion of features and an increase in the variety and number of checklists CheckAid could still become a useful application for a surgeon — but at this time I cannot recommend it.

APP CHECKLIST
References included for clinical information: N/A
Disclaimer included in the app: Yes
Authorship identified: Yes
Conflicts of Interest statement available: No
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Mechanism for Contacting Developer Included: Yes
Date since last update: [9/26/14]
[For apps with health claims] Validation testing included: N/A
[For apps subject to FDA] FDA status included: N/A