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.
Hospital Pediatrics
|March 24, 2019
Summary
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.
More Related Videos
07:59Transition of Farm Pigs to Research Pigs using a Designated Checklist followed by Initiation of Clicker Training - a Refinement Initiative
Published on: August 21, 2021
6.1K
08:46Implementation of In Vitro Drug Resistance Assays: Maximizing the Potential for Uncovering Clinically Relevant Resistance Mechanisms
Published on: December 9, 2015
11.1K
Related Concept Videos
01:15Nursing Implementation
6.0K
Implementation is the execution of the nursing care plan developed during the planning phase.
The five steps to implementing effective nursing care include reassessing the patient, reviewing and revising the existing nursing care plan, organizing the resources and care delivery, anticipating and preventing complications, and implementing nursing interventions.
The five steps to implementing effective nursing care include reassessing the patient, reviewing and revising the existing nursing care plan, organizing the resources and care delivery, anticipating and preventing complications, and implementing nursing interventions.
6.0K
01:26Pharmacokinetics in Pediatric Patients: Drug Excretion
220
In pediatric medicine, understanding the renal function and drug elimination nuances is crucial for administering safe and effective treatments. Newborns, in particular, display markedly slower renal functions than adults, profoundly affecting how drugs are cleared from their bodies. This slower drug clearance requires clinicians to extend the dosing intervals for many medications to prevent drug accumulation and toxicity while ensuring therapeutic efficacy.One key area where these adjustments...
220
01:17Pharmacokinetics in Pediatric Patients: Drug Distribution
278
Drug distribution in the pediatric population exhibits unique challenges and considerations due to the physiological differences between children, particularly neonates and infants, and adults. A crucial aspect of pediatric pharmacology is understanding how these differences impact the pharmacokinetics of various drugs, necessitating age-specific dosing strategies to ensure efficacy and safety.Neonates and infants have a higher total body water content, ~75%–90% of their body weight,...
278
01:24Pharmacokinetics in Pediatric Patients: Drug Metabolism
206
In pediatric care, understanding the nuances of hepatic drug metabolism is crucial, as it significantly differs from that of adults. This divergence is primarily due to the developmental stage of drug-metabolizing enzymes, which affects how medications are processed in the body. In neonates, for instance, the activity of Phase I enzymes—critical for the initial breakdown of drugs—is markedly reduced, functioning at just 20–40% of the levels seen in adults. This reduction poses...
206
01:23Pharmacokinetics in Pediatric Patients: Overview and Drug Absorption
264
Understanding the physiological differences in the pediatric population is crucial for effective pharmacotherapy. Neonates, infants, and children exhibit significant variations in gastric pH, gastric emptying time, intestinal transit time, and biliary function. These variations profoundly affect oral drug absorption, necessitating a nuanced approach to pediatric dosing.Neonates present with a unique physiological profile, having a gastric pH greater than 4 and faster and more irregular gastric...
264
01:16Clinical Trials
10.2K
Clinical trials are prospective experimental studies conducted on humans to determine the safety and efficacy of treatments, drugs, diet methods, and medical devices. Using statistics in clinical trials enables researchers to derive reasonable and accurate conclusions from the collected data, allowing them to make wise decisions in uncertain situations. In medical research, statistical methods are crucial for preventing errors and bias.
There are four phases in a clinical trial. A phase one...
There are four phases in a clinical trial. A phase one...
10.2K