title: Prompting physicians to address a daily checklist and process of care and clinical outcomes: a single-site study.
abstract: BACKGROUND
  Checklists may reduce errors of omission for critically ill patients.
  
  
  OBJECTIVE
  To determine whether prompting to use a checklist improves process of care and clinical outcomes.
  
  
  METHODS
  We conducted a cohort study in the medical intensive care unit (MICU) of a tertiary care university hospital. Patients admitted to either of two independent MICU teams were included. Intervention team physicians were prompted to address six parameters from a daily rounding checklist if overlooked during morning work rounds. The second team (control) used the identical checklist without prompting.
  
  
  RESULTS
  One hundred and forty prompted group patients were compared with 125 control and 1,283 preintervention patients. Compared with control, prompting increased median ventilator-free duration, decreased empirical antibiotic and central venous catheter duration, and increased rates of deep vein thrombosis and stress ulcer prophylaxis. Prompted group patients had lower risk-adjusted ICU mortality compared with the control group (odds ratio, 0.36; 95% confidence interval, 0.13-0.96; P = 0.041) and lower hospital mortality compared with the control group (10.0 vs. 20.8%; P = 0.014), which remained significant after risk adjustment (odds ratio, 0.34; 95% confidence interval, 0.15-0.76; P = 0.008). Observed-to-predicted ICU length of stay was lower in the prompted group compared with control (0.59 vs. 0.87; P = 0.02). Checklist availability alone did not improve mortality or length of stay compared with preintervention patients.
  
  
  CONCLUSIONS
  In this single-site, preliminary study, checklist-based prompting improved multiple processes of care, and may have improved mortality and length of stay, compared with a stand-alone checklist. The manner in which checklists are implemented is of great consequence in the care of critically ill patients.
authors: Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA. curtisweiss@fsm.northwestern.edu
authors: Curtis H
authors: CH
authors: Weiss
authors: Farzad
authors: F
authors: Moazed
authors: Colleen A
authors: CA
authors: McEvoy
authors: Benjamin D
authors: BD
authors: Singer
authors: Igal
authors: I
authors: Szleifer
authors: Luís A N
authors: LA
authors: Amaral
authors: Mary
authors: M
authors: Kwasny
authors: Charles M
authors: CM
authors: Watts
authors: Stephen D
authors: SD
authors: Persell
authors: David W
authors: DW
authors: Baker
authors: Jacob I
authors: JI
authors: Sznajder
authors: Richard G
authors: RG
authors: Wunderink
references: N Engl J Med. 2006 Dec 28;355(26):2725-32
references: 17192537
references: Am J Respir Crit Care Med. 2010 Dec 15;182(12):1463-4
references: 21159904
references: J Trauma. 2008 Jan;64(1):22-7; discussion 27-9
references: 18188094
references: Am J Respir Crit Care Med. 2005 Feb 15;171(4):388-416
references: 15699079
references: Am J Respir Crit Care Med. 1998 Feb;157(2):531-9
references: 9476869
references: Acad Med. 2009 Dec;84(12):1719-26
references: 19940579
references: Crit Care Med. 2006 Oct;34(10):2517-29
references: 16932234
references: Proc Natl Acad Sci U S A. 2008 Nov 25;105(47):18153-8
references: 19017788
references: Am J Respir Crit Care Med. 2000 Aug;162(2 Pt 1):505-11
references: 10934078
references: Crit Care Med. 2004 Oct;32(10):2014-20
references: 15483409
references: Ann Intern Med. 2000 Apr 18;132(8):621-30
references: 10766680
references: Am J Respir Crit Care Med. 2010 Dec 15;182(12):1461-2
references: 21159903
references: N Engl J Med. 2000 May 18;342(20):1471-7
references: 10816184
references: Am J Respir Crit Care Med. 1995 Jul;152(1):231-40
references: 7599829
references: Crit Care Med. 2009 Oct;37(10):2775-81
references: 19581803
references: Anesth Analg. 2005 Jul;101(1):246-50, table of contents
references: 15976240
references: N Engl J Med. 2006 Dec 21;355(25):2619-30
references: 17182987
references: Med J Aust. 1995 Nov 6;163(9):458-71
references: 7476634
references: N Engl J Med. 2009 Jan 29;360(5):491-9
references: 19144931
references: Lancet. 2004 Apr 10;363(9416):1224-30
references: 15081657
references: JAMA. 1996 Mar 20;275(11):866-9
references: 8596225
references: Br J Anaesth. 2004 Jun;92(6):793-9
references: 15121724
references: Am J Respir Crit Care Med. 1999 Jul;160(1):358-67
references: 10390426
references: J Crit Care. 2006 Sep;21(3):231-5
references: 16990087
references: Intensive Care Med. 2007 Aug;33(8):1369-78
references: 17558493
references: New Yorker. 2007 Dec 10;:86-101
references: 18084821
references: JAMA. 2011 Jan 26;305(4):363-72
references: 21248161
references: Chest. 2009 Sep;136(3):759-764
references: 19736189
references: Crit Care Med. 2006 May;34(5):1297-310
references: 16540951