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Effectiveness of a Daily Rounding Checklist on Processes of Care and Outcomes in Diverse Pediatric Intensive Care
Rahul Kashyap1,2, Srinivas Murthy3, Grace M Arteaga2,4
1Department of Anesthesiology and Peri-operative Medicine, Mayo Clinic, Rochester, MN, USA.
Insights
Implementing daily care checklists in pediatric intensive care units (PICUs) reduced patient length of stay and improved adherence to care guidelines. This patient safety intervention showed promising results in resource-limited settings.
Area of Science:
- Critical Care Medicine
- Patient Safety
- Healthcare Management
Background:
- Patient safety is enhanced by implementing checklists in clinical practice.
- Pediatric intensive care units (PICUs) often face resource limitations.
- Daily care process checklists can potentially improve outcomes in these settings.
Purpose of the Study:
- To evaluate the effectiveness of a daily care checklist in resource-limited pediatric intensive care units.
- To assess the impact of checklist implementation on patient outcomes and care processes.
Main Methods:
- A prospective before-and-after study was conducted in eight PICUs across five countries.
- Checklists for daily care processes were implemented during ICU rounds.
- Data were collected from 735 patients before and after checklist implementation.
Main Results:
- ICU length of stay significantly decreased post-implementation (9.4 to 7.3 days).
- Adherence to care recommendations improved, with decreased exposure to mechanical ventilation, central lines, and urinary catheters.
- No significant difference was observed in hospital or ICU mortality.
Conclusions:
- Daily care checklists in PICUs had a marginal impact on overall outcomes but improved adherence to care guidelines.
- The intervention led to a decreased length of stay for patients.
- Checklist implementation is a valuable strategy for enhancing care processes in resource-limited PICUs.
Background:
Implementation of checklists has been shown to be effective in improving patient safety. This study aims to evaluate the effectiveness of implementation of a checklist for daily care processes into clinical practice of pediatric intensive care units (PICUs) with limited resources.
Methods:
Prospective before-after study in eight PICUs from China, Congo, Croatia, Fiji, and India after implementation of a daily checklist into the ICU rounds.
Results:
Seven hundred and thirty-five patients from eight centers were enrolled between 2015 and 2017. Baseline stage had 292 patients and post-implementation 443. The ICU length of stay post-implementation decreased significantly [9.4 (4-15.5) vs. 7.3 (3.4-13.4) days, p = 0.01], with a nominal improvement in the hospital length of stay [15.4 (8.4-25) vs. 12.6 (7.5-24.4) days, p = 0.055]. The hospital mortality and ICU mortality between baseline group and post-implementation group did not show a significant difference, 14.4% vs. 11.3%; p = 0.22 for each. There was a variable impact of checklist implementation on adherence to various processes of care recommendations. A decreased exposure in days was noticed for; mechanical ventilation from 42.6% to 33.8%, p < 0.01; central line from 31.3% to 25.3%, p < 0.01; and urinary catheter from 30.6% to 24.4%, p < 0.01. Although there was an increased utilization of antimicrobials (89.9-93.2%, p < 0.01).
Conclusions:
Checklists for the treatment of acute illness and injury in the PICU setting marginally impacted the outcome and processes of care. The intervention led to increasing adherence with guidelines in multiple ICU processes and led to decreased length of stay.
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