title: Checklist-styled daily sign-out rounds improve hospital throughput in a major trauma center.
abstract: The checklist concept has received much attention as a result of its ability to improve patient care by minimizing complications. We hypothesized daily sign-out rounds using a checklist, by improving team communication and consistency of clinical care, could lead to expedited throughput for patients at a major trauma center. A retrospective study examined patients admitted to a mature trauma center. Two time periods, PRE (September 2008 to January 2009) and POST (September 2009 to January 2010), were selected to match for seasonal variation in admission diagnosis. An organ system-based checklist was used during daily sign-out for all admitted trauma patients in the POST period. We examined discharge status, complications and rates, and intensive care unit (ICU) and overall hospital length of stay for differences. There were similar numbers of patients (824 PRE vs 798 POST) admitted in these two cohorts. We found no statistical differences in the incidence of complications or mortality rate. We did discover statistically significant differences in the median ICU days (2 PRE vs 1 POST, P = 0.007) as well as median hospital length of stay (2 days, interquartile differences Q1 to Q3 PRE [1 to 5] and POST [1 to 4] P = 0.000). These trends remained valid even among the severely injured (Injury Severity Score 16 or greater) with a hospital length of stay of 5 (PRE) versus 3 days (POST; P = 0.021). A simple, organ system-based checklist can be successfully adopted for daily sign-out round on a busy, multiprovider trauma service. We were able to expedite trauma patient throughput in both ICU and overall hospital stays with a trend toward decreasing mortality. This improved throughput may potentially translate into a cost saving for the hospital.
authors.affiliation: Division of Trauma/Critical Care, Lancaster General Health, Lancaster, Pennsylvania, USA.
authors.forename: John C
authors.initials: JC
authors.lastname: Lee
authors.forename: Michael
authors.initials: M
authors.lastname: Horst
authors.forename: Amelia
authors.initials: A
authors.lastname: Rogers
authors.forename: Frederick B
authors.initials: FB
authors.lastname: Rogers
authors.forename: Daniel
authors.initials: D
authors.lastname: Wu
authors.forename: Tracy
authors.initials: T
authors.lastname: Evans
authors.forename: Mathew
authors.initials: M
authors.lastname: Edavettal
mesh_terms: D057189:Checklist; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data*; D008875:Middle Aged; D010348:Patient Care Team / Q000458:organization & administration / Q000592:standards*; D010351:Patient Discharge; D062209:Patient Handoff / Q000458:organization & administration / Q000592:standards*; D010414:Pennsylvania; D011183:Postoperative Complications / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D014193:Trauma Centers / Q000458:organization & administration / Q000592:standards*; D014947:Wounds and Injuries / Q000401:mortality / Q000601:surgery*