Measurable outcomes of quality improvement using a daily quality rounds checklist: two-year prospective analysis of sustainability in a surgical intensive care unit.
BACKGROUND
The use of a "quality rounds checklist" (QRC) is an effective tool for improving compliance with evidence-based preventative measures and outcomes in the surgical intensive care unit (SICU). Our aim was to evaluate the long-term sustainability and outcome impact of this quality improvement strategy.


METHODS
Prospective observational study evaluates the use of the QRC in the SICU from July 2009 to June 2011. Daily compliance with evidence-based prophylactic measures was assessed using the QRC and reviewed monthly at a multidisciplinary meeting. Logistic regression was performed to evaluate patterns of compliance over time. Current compliance was compared with previously reported rates, and the impact on outcomes including catheter-related blood stream infection and ventilator-associated pneumonia rates was examined.


RESULTS
Over 2 years, 2,472 patients were admitted to the SICU. Mean (SD) age was 42.2 (22.4) years, 79% were male, and 35% had an Injury Severity Score (ISS) of greater than 15. The rate of compliance with head-of-bed elevation significantly improved during the study period (p = 0.01 for trend), with an overall compliance of 97%. Both deep venous thrombosis prophylaxis and gastrointestinal bleed prophylaxis compliance remained stable, with overall rates of 98% and 96%, respectively. The use of sedation holidays also remained stable, with an overall compliance rate of 94%. Compared with our previously published data, the compliance rates with preventative measures were stable or significantly improved; the incidence of catheter-related blood stream infections was lower (0.85/1,000 vs. 4.98/1,000 catheter days, p < 0.001); and the incidence of ventilator-associated pneumonia downtrended (1.66/1,000 vs. 8.74/1,000 ventilator days, p = 0.07).


CONCLUSIONS
Two years after implementation of a QRC, sustainable high rates of compliance with clinically relevant preventative measures in a SICU was demonstrated with minimal fading of clinically relevant outcomes.


METHODS
Therapeutic study, level IV.
From the Division of Acute Care Surgery (P.G.R.T., K.I., N.M., M.B., H.B., D.D.), University of Southern California, Los Angeles, California; and R. Adams Cowley Shock Trauma Center (J.D.), University of Maryland Medical Center, Baltimore, Maryland.
Pedro G R
PG
Teixeira
Kenji
K
Inaba
Joseph
J
Dubose
Nicolas
N
Melo
Margarita
M
Bass
Howard
H
Belzberg
Demetrios
D
Demetriades
D000328:Adult; D055499:Catheter-Related Infections / Q000453:epidemiology; D057189:Checklist; D003422:Critical Care / Q000379:methods / Q000458:organization & administration / Q000592:standards; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000517:prevention & control; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D007362:Intensive Care Units / Q000592:standards* / Q000706:statistics & numerical data; D008297:Male; D010043:Outcome and Process Assessment, Health Care / Q000379:methods; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology; D011446:Prospective Studies; D058996:Quality Improvement / Q000458:organization & administration* / Q000592:standards; D019984:Quality Indicators, Health Care; D020246:Venous Thrombosis / Q000517:prevention & control