Rahul Kashyap1,2, Srinivas Murthy3, Grace M Arteaga2,4, Yue Dong1,2, Lindsey Cooper5, Tanja Kovacevic6, Chetak Basavaraja7, Hong Ren8, Lina Qiao9, Guoying Zhang10, Kannan Sridharan11, Ping Jin12, Tao Wang10, Ilisapeci Tuibeqa13, An Kang8, Mandyam Dhanti Ravi7, Ebru Ongun14, Ognjen Gajic2,15, Sandeep Tripathi2,4,16. 1. Department of Anesthesiology and Peri-operative Medicine, Mayo Clinic, Rochester, MN, USA. 2. METRIC-Multidisciplinary and Translational Research in Intensive Care Medicine, Mayo Clinic, Rochester, MN, USA. 3. Division of Critical Care, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada. 4. Pediatric Critical Care Medicine, Mayo Clinic, Rochester, MN, USA. 5. Department of Pediatrics/Intensive Care, Centre Medicale Evangelique-Nyankunde, Nyankunde, Democratic Republic of the Congo. 6. School of Medicine and University Hospital of Split, Split, Croatia. 7. JSS Academy of Higher Education and Research (JSSAHER), JSS Hospital, Mysuru, KA, India. 8. Pediatric Intensive Care Unit, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China. 9. Sichuan University West China Second Hospital, Chengdu, China. 10. Chengdu Women and Children's central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China. 11. Department of Pharmacology, College of Medicine, Nursing and Health Sciences, Fiji national University, Suva, Fiji. 12. Bao'an Maternity & Child Health Hospital, Shenzhen, China. 13. Department of Pediatrics, Colonial war memorial Hospital, Suva, Fiji. 14. Akdeniz University Hospital, Antalya, Turkey. 15. Divison of Pulmonary and Care Medicine, Mayo Clinic, Rochester, MN, USA. 16. Pediatric Critical Care Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL, USA.
Abstract
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.
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.
Authors: Paul A Harris; Robert Taylor; Robert Thielke; Jonathon Payne; Nathaniel Gonzalez; Jose G Conde Journal: J Biomed Inform Date: 2008-09-30 Impact factor: 6.317
Authors: Meghan M Cirulis; Mitchell T Hamele; Chris R Stockmann; Tellen D Bennett; Susan L Bratton Journal: Pediatr Crit Care Med Date: 2016-02 Impact factor: 3.624