Testing the implementation of an electronic process-of-care checklist for use during morning medical rounds in a tertiary intensive care unit: a prospective before–after study

Abstract

BackgroundTo improve the delivery of important care processes in the ICU, morning ward round checklists have been implemented in a number of intensive care units (ICUs) internationally. Good quality evidence supporting their use as clinical support tools is lacking. With increased use of technology in clinical settings, integration of such tools into current work practices can be a challenge and requires evaluation. Having completed preliminary work revealing variations in practice and evidence supporting the construct validity of a process-of-care checklist, the need to develop, test and further validate an e(lectronic)-checklist in an ICU was identified.MethodsA prospective, before–after study was conducted in a 19-bed general ICU within a tertiary hospital. Data collection occurred during baseline and intervention periods for 6 weeks each, with education and training conducted over a 4-week period prior to intervention. The e-checklist was used at baseline by ICU research nurses conducting post-ward round audits. During intervention, senior medical staff completed the e-checklist after patient assessments during the morning ward rounds, and research staff conducted post-ward round audits for validity testing (via concordance measurement). To examine changes in compliance over time, checklist-level data were analysed using generalised estimating equations that factored in confounding variables, and statistical process control charts were used to evaluate unit-level data. Established measures of concordance were used to evaluate e-checklist validity.ResultsCompliance with each care component improved significantly over time; the largest improvement was for pain management (42% increase; adjusted odds ratio = 23, p < 0.001), followed by glucose management (22% increase, p < 0.001) and head-of-bed elevation (19% increase, p < 0.001), both with odds ratios greater than 10. Most detected omissions were corrected by the following day. Control charts illustrated reduced variability in care compliance over time. There was good concordance between physician and auditor e-checklist responses; seven out of nine cares had kappa values above 0.8.ConclusionImprovements in the delivery of essential daily care processes were evidenced after the introduction of an e-checklist to the morning ward rounds in an ICU. High levels of agreement between physician and independent audit responses lend support to the validity of the e-checklist.Electronic supplementary materialThe online version of this article (doi:10.1186/s13613-015-0060-1) contains supplementary material, which is available to authorized users.

Workflow for Intensive Care Unit Nurses: A Time and Motion Study

“…The results showed that the information which is accessible to the patient could potentially improve the communication processes and change the efficiency of work processes. Conroy et al (2015) introduced a valid ICU e-checklist into the morning rounds, and the delivery of essential daily care processes was improved. Kai-Hsuan et al (2020) found that the handover times were shortened and the workflow was changed after conducting an informatics system combined with an automatic reminder.…”

Bedside or not bedside: Evaluation of patient satisfaction in intensive medical rehabilitation wards

“…Other advantages of bedside visits have been suggested, although not clearly demonstrated, such as better patient understanding of their illness, higher participation in the decision-making process as well as better or more complete information provided by the patient [ 10 , 13 ]. Physician-nurse team bedside visits have been shown to improve various aspects of treatment in intensive care units and in particular pain management and mortality [ 26 – 27 ]. Only one drawback of bedside visits for conducting physicians could be demonstrated in the RCT cited above [ 16 ]: residents and medical trainees may have felt less comfortable asking questions and responding to patient’s queries.…”

Intensive care unit rounding checklists to reduce catheter-associated urinary tract infections

“…Rounding checklists are a type of reminder system that present a list of criteria in a methodological manner and helps with memory recall, standardizing practices, and providing verification. 19 Checklists are known to improve compliance with best practices in the ICU, [20][21][22] and improve interdisciplinary communication, 23 a key component of care in ICUs. Surgical checklists in the operating room have been shown to reduce morbidity and mortality, 24 but whether rounding checklists in the ICU setting have a similar impact on outcomes is unclear.…”