title: Reductions in invasive device use and care costs after institution of a daily safety checklist in a pediatric critical care unit.
abstract: BACKGROUND
  In the critical care unit, complexity of care can contribute to both medical errors and increased costs, particularly when clinicians are forced to rely on memory. Checklists can be used to improve safety and reduce cost. A number of omission-related adverse events in 2010 prompted the development of a checklist to reduce the possibility of similar future events.
  
  
  METHODS
  The PICU Safety Checklist was implemented in the pediatric ICU (PICU) at Children's Hospitals and Clinics of Minnesota. During a 21-month period, the checklist was used to prompt the care team to address quality and safety items during rounds. The initial checklist was paper, with two subsequent versions being incorporated into the electronic medical record (EMR).
  
  
  RESULTS
  The daily safety checklist was successfully implemented in the PICU. Work-flow improvements based on regular multidisciplinary feedback led to more consistent use of the checklist. Improvements on all quality and safety metrics were identified, including invasive device use, medication costs, antibiotic and laboratory test use, and compliance with standards of care. Staff satisfaction rates were > 80% for safety, communication, and collaboration.
  
  
  CONCLUSIONS
  By using a daily safety checklist in the pediatric critical care unit, we improved quality and safety, as well as the collaborative culture among all clinicians. Incorporating the checklist into the EMR improved compliance and accountability, ensuring its application to all patients. Clinicians now often individually address many checklist items outside the formal rounding process, indicating that the checklist content has become part of their usual practice. A successful implementation showing tangible clinical improvements can lead to interest and adoption in other clinical areas within the institution.
authors.forename: Rod
authors.initials: R
authors.lastname: Tarrago
authors.forename: Jeffrey E
authors.initials: JE
authors.lastname: Nowak
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Leonard
authors.forename: Nathaniel R
authors.initials: NR
authors.lastname: Payne
mesh_terms: D057189:Checklist; D003142:Communication; D003299:Cooperative Behavior; D006801:Humans; D015278:Intensive Care Units, Pediatric / Q000458:organization & administration*; D015279:Organizational Culture; D061214:Patient Safety; D011787:Quality of Health Care / Q000458:organization & administration*; D012189:Retrospective Studies; D017751:Safety Management / Q000458:organization & administration*; D057188:Workflow