The effectiveness of an intensive care quick reference checklist manual--a randomized simulation-based trial

Area of Science:

• Medical Simulation
• Intensive Care Medicine
• Patient Safety

Background:

• Effective management of intensive care unit (ICU) crises relies on timely and accurate medical staff performance.
• Standardized protocols, such as checklists, are increasingly explored to improve care delivery in high-stress medical environments.

Purpose of the Study:

• To evaluate the effectiveness of emergency procedure checklists on medical staff performance during simulated intensive care unit (ICU) crises.
• To determine if checklist use impacts the initiation and completion rates of critical treatment steps.

Main Methods:

• A prospective, single-center randomized trial was conducted in a high-fidelity simulation center, modeling an ICU environment.
• Teams of 1 ICU resident and 2 ICU nurses (n=48) completed four crisis scenarios, randomized to use checklists or not.
• Scenarios were categorized as type 1 (immediate checklist use) or type 2 (checklist use after initial diagnostic steps).

Main Results:

• Checklist use led to faster and more complete initiation of treatment items compared to unassisted performance (9 vs 7 items, P < .05).
• The benefit of checklists was more pronounced in type 2 scenarios, with more additional items completed (2 vs 1, P < .05).
• In type 2 scenarios, checklists significantly reduced the time to complete 50% and 75% of critical steps (P < .005).

Conclusions:

• Checklists demonstrably improve the completion of critical treatment steps during intensive care unit (ICU) crises.
• Checklist implementation is a promising strategy to enhance patient care and safety in critical care settings.
• The positive impact of checklists is particularly evident in complex scenarios requiring sequential decision-making.