Checklists are used in many clinical settings to improve patient safety, but prior research as documented challenges related to provider fatigue related to checklist use. This article discusses an innovative, generalizable approach to minimizing the burden of checklists and improving clinical decision making.

In 2006, clinicians at the Boston Children’s Hospital created a checklist (eSIMPLE, converted to web-based platform in 2011) used during daily interdisciplinary rounds in the pediatric intensive care unit (PICU). eSIMPLE was comprised of 6 components: sedation, invasive catheters and tubes, medications, prophylaxis, laboratory testing plan, and enteral nutrition.

In 2017, researchers overhauled the tool to enhance situational awareness and clinical decision support (CDS) by incorporating data automatically pulled from the electronic health record system (eSIMPLER). Examples of enhancements include displaying the number of days sedatives and antimicrobials have been administered, automatically determining a patient’s artificial airway status and history, and displaying orders for venous thromboembolism (VTE) prophylaxis.

An evaluation of the eSIMPLER checklist concluded that completion rates were similar to eSIMPLE, but that the enhanced checklist required less time to complete per patient and improved certain process measures, such as discordance between EHR orders and user-recorded indications for stress ulcer prophylaxis, rate of VTE prophylaxis prescribing, and recognition of reduced renal function