Implementation of a mandatory checklist of protocols and objectives improves compliance with a wide range of evidence-based intensive care unit practices.
OBJECTIVE
To determine a) if a checklist covering a diverse group of intensive care unit protocols and objectives would improve clinician consideration of these domains and b) if improved consideration would change practice patterns.


METHODS
Pre- and post observational study.


METHODS
A 24-bed surgical/burn/trauma intensive care unit in a teaching hospital.


METHODS
A total of 1399 patients admitted between June 2006 and May 2007.


METHODS
The first component of the study evaluated whether mandating verbal review of a checklist covering 14 intensive care unit best practices altered verbal consideration of these domains. Evaluation was performed using real-time bedside audits on morning rounds. The second component evaluated whether the checklist altered implementation of these domains by changing practice patterns. Evaluation was performed by analyzing data from the Project IMPACT database after patients left the intensive care unit.


RESULTS
Verbal consideration of evaluable domains improved from 90.9% (530/583) to 99.7% (669/671, p < .0001) after verbal review of the checklist was mandated. Bedside consideration improved on the use of deep venous thrombosis prophylaxis (p < .05), stress ulcer prophylaxis (p < .01), oral care for ventilated patients (p < 0.01), electrolyte repletion (p < .01), initiation of physical therapy (p < .05), and documentation of restraint orders (p < .0001). Mandatory verbal review of the checklist resulted in a greater than two-fold increase in transferring patients out of the intensive care unit on telemetry (16% vs. 35%, p < .0001) and initiation of physical therapy (28% vs. 42%, p < .0001) compared with baseline practice.


CONCLUSIONS
A mandatory verbal review of a checklist covering a wide range of objectives and goals at each patient's bedside is an effective method to improve both consideration and implementation of intensive care unit best practices. A bedside checklist is a simple, cost-effective method to prevent errors of omission in basic domains of intensive care unit management that might otherwise be forgotten in the setting of more urgent care requirements.
Byrnes
Matthew C
MC
Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.
Schuerer
Douglas J E
DJ
Schallom
Marilyn E
ME
Sona
Carrie S
CS
Mazuski
John E
JE
Taylor
Beth E
BE
McKenzie
Wendi
W
Thomas
James M
JM
Emerson
Jeffrey S
JS
Nemeth
Jennifer L
JL
Bailey
Ruth A
RA
Boyle
Walter A
WA
Buchman
Timothy G
TG
Coopersmith
Craig M
CM
D003362:Cost-Benefit Analysis / Q000592:standards; D003422:Critical Care / Q000191:economics / Q000592:standards*; D019317:Evidence-Based Medicine / Q000191:economics / Q000592:standards*; D005260:Female; D019983:Guideline Adherence / Q000191:economics / Q000592:standards*; D006284:Health Plan Implementation / Q000191:economics; D017052:Hospital Mortality; D006784:Hospitals, Teaching / Q000191:economics; D006785:Hospitals, University; D006801:Humans; D007362:Intensive Care Units / Q000191:economics / Q000706:statistics & numerical data; D007902:Length of Stay / Q000191:economics; D008297:Male; D037141:Mandatory Programs / Q000191:economics / Q000706:statistics & numerical data; D019300:Medical Errors / Q000517:prevention & control; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data; D010360:Patient Transfer / Q000191:economics / Q000592:standards; D011785:Quality Assurance, Health Care / Q000191:economics / Q000592:standards; D016896:Treatment Outcome; D014861:Washington