Intensive Care Unit Rounding Checklist Implementation. Effect of Accountability Measures on Physician Compliance

Carlos, W. Graham; Patel, Dina; Vannostrand, Keriann M; Gupta, Shikha; Cucci, Anthony; Bosslet, Gabriel T.

doi:10.1513/annalsats.201410-494oc

Cited by 18 publications

(17 citation statements)

References 16 publications

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“…The third quarter demonstrated marked improvement in correction rates for both the teaching and private services, as the checklist became more accepted by the team, aligned with the mission and better integrated into the workflow of the unit. Similar degrees in improvement in compliance with intensive care unit best practices were achieved with specialty aligned checklists applied in surgical, trauma and intensive care units [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37]. In addition, this study also validated that verbal review is an effective means to improve application of CCU best practices as has been shown in other ICU settings [23,36].…”

Section: Discussionsupporting

confidence: 68%

“…Checklists are support tools to be used by healthcare providers, especially operating in challenging and complex environments such as intensive care units. They serve as cognitive and forcing function reminders to ensure safe practices, team communication and coordination and the application of evidence-based preventive strategies and guideline recommended therapies [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37].…”

Section: Introductionmentioning

confidence: 99%

“…Despite proven effectiveness in mostly observational studies, especially when the tool is embedded into care reliably, checklists are not uniformly or consistently used. Many challenges exist in their implementation and sustainable use and proving a direct relationship between the use of the tool and outcomes [27][28][29] has been evasive. Even though daily rounding checklists have been well described in medical, trauma, and pediatric and surgical intensive care units [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] with favorable results, there is no reported experience on the use and impact of a daily care checklist in the coronary care unit (CCU) setting, focusing on optimizing the management of complex and challenging critically ill cardiac patients and assuring the application of guideline recommended care.…”

Section: Introductionmentioning

confidence: 99%

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Development and Implementation of a Coronary Care Unit Quality Improvement Checklist

Shuaib¹,

Gugudis²,

Gugudis³

et al. 2018

JCTCD

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Introduction: Real time checklists, adopted from high reliability industries, have been used in many healthcare settings to assure that key care deliverables and processes are applied consistently. The purpose of this quality improvement initiative is to describe the development and implementation of a daily rounding critical cardiac care checklist and assess its impact on increasing compliance with guideline-recommended cardiac performance measures. Methods & Design: This is a prospective, observational cohort study in the coronary care unit (CCU) of a university-affiliated major teaching hospital in southeastern Michigan, from Jan 2014-Jan 2015. Each CCU cardiac patient served as their own control, utilizing each patient day for monitoring of adherence to 20 key care deliverables (based on eligibility) as audited by a quality technician using an aligned checklist. The rate of adherence to the items on the checklist, and the rate of corrections which occurred within 24 hours of being identified as an omission were measured monthly. The results were then summed up into four quarters and compared between teaching and non-teaching services. Results: During the study period, the total number of patients enrolled was 550 patients. These patients were followed for a total number of 1457 days. The overall rate of initial adherence to the items on the checklist was 88.4%, and it improved to 95.5% with the use of the checklist in the final adherence rates. Both initial and final rates of adherence were found to be higher on the teaching service compared to the non-teaching service. Conclusion: The use and application of a daily CCU checklist by an assigned quality technician can identify and correct deficiencies in desired care. Despite the intensity of the interventions, the enhanced engagement and alignment of the nursing and physician staff and the reliable processes put into place, the goal of achieving 100% adherence rates to eligible and appropriate clinical measures was not achieved. This project provided a great deal of insight into the barriers, challenges and limitations that need to be overcome for successful implementation, utilization, value and sustainability of an applied healthcare checklist, to improve intended and desired performance measures and drive favorable outcomes in a real world setting.

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Section: Discussionsupporting

confidence: 68%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Development and Implementation of a Coronary Care Unit Quality Improvement Checklist

Shuaib¹,

Gugudis²,

Gugudis³

et al. 2018

JCTCD

View full text Add to dashboard Cite

show abstract

“…A sample ICU interprofessional rounding checklist was published by Carlos and colleagues, which included information about central and arterial lines, glucose control, restraints, indwelling catheter, nutrition goal rate, pressure ulcer, antibiotics, deep vein thrombosis prophylaxis, gastrointestinal prophylaxis, intubation, sedation vacation, head of bed at 30°, spontaneous breathing trial, physical therapy/occupational therapy or physical medicine and rehabilitation, family updated within 24 hours, goals/disposition/case manager, and code status. However, there was no reference to advance care planning, an advance directive, physician orders for life‐sustaining treatment (POLST), or patient's quality‐of‐life goals being met with current medical interventions.…”

Section: Icu Interprofessional Rounds and Family Meetings: Function Amentioning

confidence: 99%

Role of the Nutrition Support Clinician on a Hospital Bioethics Committee

2019

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Hospital bioethics committees comprise a diverse group of healthcare professionals to deal with ethical issues within the institution that arise during patient care. The nutrition support clinicians (NSCs) have an important role on a bioethics committee because of their knowledge and expertise of different nutrition routes and the benefits vs burdens and risks of these modalities, both enteral and parenteral nutrition. Ethics expertise is built on an understanding of ethical principles, when applied in clinical ethics, using critical thinking to prevent ethical dilemmas and to assist in healthcare decision making with a focus on patient-centered care. The NSCs have the opportunity to address ethics during direct patient care with their participation in the intensive care unit interprofessional rounds, family meetings, and surrogate meetings. Evident in ethical dilemmas is often the lack of advance care planning by patients and their family members concerning healthcare wishes for when the individual is unable to communicate their preferences for lifesustaining therapies, including nutrition support. NSCs, as hospital bioethics committee members, are able to support the initiative of National Healthcare Decisions Day to help educate other healthcare clinicians and the public about the importance of advance care planning with communication of healthcare wishes and completion of an advance directive. Components addressed in the article are incorporated into a comprehensive ethics case study, highlighting the role of NSCs. (Nutr Clin Pract. 2019;34:869-880) From the

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“…A culture of routine surveillance and checklists, customized to the needs of the individual patient, are valuable additions to a clinical review, forming the basis of more formal audits of practice, clinical indicators, and benchmarking [28][29][30]. Vincent described ''FASTHUG'' as an approach to routine patient review [31].…”

mentioning

confidence: 99%

Prevention of Nosocomial Infection in the Neurosciences Intensive Care Unit: Remember the Basics

Boots

2016

Neurocrit Care

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Intensive Care Unit Rounding Checklist Implementation. Effect of Accountability Measures on Physician Compliance

Cited by 18 publications

References 16 publications

Development and Implementation of a Coronary Care Unit Quality Improvement Checklist

Development and Implementation of a Coronary Care Unit Quality Improvement Checklist

Role of the Nutrition Support Clinician on a Hospital Bioethics Committee

Prevention of Nosocomial Infection in the Neurosciences Intensive Care Unit: Remember the Basics

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