Module 6
Reliability refers to how consistently an intervention is carried out as intended — producing the desired result every time it’s applied, across different providers, shifts, and circumstances.
What Makes an Intervention More Reliable?
- Standardization: Clear, written protocols that reduce reliance on memory
- Simplification: Fewer steps = fewer opportunities for failure
- Reminders and prompts: EMR alerts, checklists, visual cues at point of care
- Training and practice: Repeated exposure until the process becomes habit
- Accountability: Regular audits and visible tracking that make compliance transparent
- Redundancy: Backup checks (e.g., charge nurse verifies screening completion at shift end)
Levels of Reliability
| Level | Description | What It Looks Like in Practice |
|---|---|---|
~80% reliability |
The change is done most of the time. Relies on memory, goodwill, or individual initiative. |
Fragile under stress. When the ED is busy or staff turn over, compliance drops. Dependent on champions. Example: Staff completes a one-time training on the pediatric behavioral health checklist. Without reminders or system supports, compliance fades as memory lapses and new staff onboard. |
~95% reliability |
The change is embedded in workflow. Supported by reminders, checklists, or EMR prompts. |
Consistent across most staff and shifts. Resilient to moderate stress. Requires maintenance. Example: A laminated prompt card on the pediatric call clipboard reminds EMS providers to complete the behavioral health checklist during high-acuity calls. |
>99% reliability (‘fail-safe’) |
The system is designed so the right thing happens automatically. Error has to be actively forced. |
The target for highest-stakes processes. Example: EMR requires a safety plan field before discharge can be completed. Example: EMR requires a safety plan field before discharge can be completed. |
💡 Suicide Risk Screening Reliability: EMS Context
An EMS system introduces a new pediatric behavioral health checklist. Initially, compliance is ~70% providers complete it when they remember. After adding a laminated prompt card on the clipboard used for all pediatric calls, compliance rises to 92%. After building the checklist into the electronic run report as a required field that must be completed before the report can be submitted, compliance exceeds 98%.
Result: Moving from individual memory to structured reminders to system-embedded prompts progressively increases reliability. Each step removes reliance on individual initiative.