Implementation of a General Pediatric Clinical Rounding Checklist
Nicholas A Clark1, Stephanie Burrus2, Troy Richardson2,3
1Children's Mercy Kansas City, Kansas City, Missouri; and nclark1@cmh.edu.
Insights
A pediatric rounding checklist increased use but did not reduce length of stay. However, it significantly decreased cardiorespiratory monitor (CRM) duration in both general and complex pediatric patients.
Area of Science:
- Pediatric Hospital Medicine
- Quality Improvement in Healthcare
- Clinical Workflow Optimization
Background:
- Checklists are proven to enhance patient outcomes in healthcare but are underutilized during general pediatric rounds.
- A quality improvement initiative aimed to standardize hospital care delivery for a general pediatric unit, targeting an overall 10% reduction in length of stay (LOS) within 12 months.
Purpose of the Study:
- To implement and assess the impact of a clinical rounding checklist on patient care and length of stay in a general pediatric unit.
- To evaluate the effectiveness of a standardized checklist in improving 8 key aspects of hospital care.
- To determine if checklist implementation could lead to a 10% decrease in length of stay.
Main Methods:
- A clinical rounding checklist was developed by consensus among teaching faculty for a general pediatrics unit at a children's hospital.
- The checklist was implemented over 12 months using iterative plan-do-study-act cycles in a targeted medical unit.
- Changes in key performance indicators were assessed using control charts.
Main Results:
- Checklist utilization increased significantly from 61% to 96% during the implementation phase.
- Length of stay (LOS) showed no significant change. However, cardiorespiratory monitor (CRM) duration decreased by 28% (17.3 hours) within 4 months and was sustained.
- A similar CRM reduction of 29% (22.5 hours) was observed in the medically complex patient subgroup, with no adverse impact on patient safety metrics like readmissions or critical events.
Conclusions:
- The clinical rounding checklist improved care in only one of the eight targeted domains, with no significant impact on overall length of stay.
- Significant reductions in cardiorespiratory monitor (CRM) duration were achieved and sustained for both routine and medically complex pediatric patients without compromising safety.
- Further research is necessary to identify specific checklist components that may yield broader benefits for patient outcomes.
Background:
Checklists have been found to improve patient outcomes in a variety of health care settings, but use is rare during general pediatric rounds. We aimed to decrease length of stay (LOS) by 10% within 12 months through the standardized delivery of 8 aspects of hospital care for the general pediatric unit.
Methods:
For the general pediatrics unit at our freestanding children's hospital, a clinical rounding checklist was developed through a consensus of teaching faculty. Iterative plan-do-study-act cycles were conducted in a targeted medical unit over a 12-month period. We assessed change using control charts.
Results:
Checklist use increased from 61% to 96% early in the implementation phase. LOS (72 hours) was relatively unchanged. Cardiorespiratory monitor (CRM) duration was reduced by 28% (17.3 hours) within 4 months and was sustained for more than 12 months. A similar CRM reduction of 29% (22.5 hours) was seen in our medically complex patient subgroup. No clinically significant change was appreciated in central line, peripheral intravenous (IV) catheter, IV fluid, or IV medication duration. Thirty-day readmissions, code blue events, and rapid response team activations were not impacted.
Conclusions:
The use of a clinical rounding checklist on the general pediatric floor improved care in only 1 of 8 targeted domains. LOS did not change significantly over the project's duration. CRM duration was significantly reduced in both routine patients and medically complex children, and these improvements were sustained without impacting patient safety. More study is needed to determine which checklist components, if any, may prove beneficial to patient outcomes.
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