Perceptions of rounding checklists in the intensive care unit: a qualitative study

Area of Science:

• Quality Improvement in Healthcare
• Clinical Operations
• Patient Safety

Background:

• Rounding checklists are increasingly used in intensive care units (ICUs) for quality improvement.
• Studies on their effectiveness have yielded conflicting results.
• Understanding provider perceptions is crucial for optimizing checklist use.

Purpose of the Study:

• To explore intensive care unit (ICU) providers' perceptions of rounding checklists.
• To identify barriers and facilitators to effective checklist utilization.
• To develop a framework for improved implementation.

Main Methods:

• Qualitative study conducted in 32 ICUs across 14 hospitals.
• Employed direct observation of daily rounds and semistructured interviews with clinicians.
• Thematic analysis of observational and interview data using inductive and deductive approaches.

Main Results:

• 89 interviews and 114 hours of observation were completed; 12 ICUs used checklists, 20 did not.
• Providers viewed checklists as reminders for evidence-based practices, tools for shared understanding, and efficiency enhancers.
• Checklists were perceived as unhelpful when overstandardizing care or irrelevant to ICU needs.

Conclusions:

• Checklist effectiveness is influenced by relevance, brevity, consistency, and workflow integration.
• Insights suggest a framework for effective implementation focusing on feedback and accountability.
• Optimizing checklist use can potentially improve ICU outcomes.