title: Creation of the Prevention of Organ Failure Checklist. A Multidisciplinary Approach Using the Modified Delphi Technique.
abstract: Respiratory failure represents a major risk for morbidity and mortality. Although generally managed in the intensive care unit (ICU), respiratory failure often begins elsewhere. Checklists of care processes to minimize the duration of mechanical ventilation and adverse events are routinely used in the ICU, but are uncommonly used outside the ICU.
  
  
  
  To develop consensus among a multidisciplinary expert panel on care practices to include in a checklist of best practices for critically ill patients with respiratory failure before and after ICU admission.
  
  
  
  A multidisciplinary expert panel was assembled. The panel was tasked with creating a checklist of care processes aimed at decreasing progression to respiratory failure, duration of mechanical ventilation, mortality in mechanical ventilation, and adverse events. Over the course of multiple teleconferences and e-mail communications, the Prevention of Organ Failure Checklist list was reviewed, refined, and voted upon. Items that received greater than 75% of the vote were included in the final checklist.
  
  
  
  Using a modified Delphi process, the expert panel was able to compile Prevention of Organ Failure Checklist into 20 items that aimed to decrease mechanical ventilation by assessing the causes of acute respiratory failure, ventilation strategies, sedation, and general critical care processes, as well as to avoid unwanted or nonbeneficial interventions.
  
  
  
  The modified Delphi process identified readily available preventative interventions suitable for checklist implementation in patients with or progressing to respiratory failure even before ICU admission.
authors.affiliation: 1 Division of Critical Care, Montefiore Medical Center, The Bronx, New York.|2 Department of Surgery, Maimonides Medical Center, Brooklyn, New York.
authors.forename: Joshua S
authors.initials: JS
authors.lastname: Pearl
authors.affiliation: 3 Department of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota; and.
authors.forename: Ognjen
authors.initials: O
authors.lastname: Gajic
authors.affiliation: 3 Department of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota; and.
authors.forename: Yue
authors.initials: Y
authors.lastname: Dong
authors.affiliation: 4 Department of Anesthesia, Mayo Clinic, Rochester, Minnesota.
authors.forename: Vitaly
authors.initials: V
authors.lastname: Herasevich
authors.affiliation: 1 Division of Critical Care, Montefiore Medical Center, The Bronx, New York.
authors.forename: Michelle N
authors.initials: MN
authors.lastname: Gong
mesh_terms: D057189:Checklist; D032921:Consensus; D003422:Critical Care / Q000592:standards*; D016638:Critical Illness / Q000628:therapy*; D003697:Delphi Technique; D006801:Humans; D007362:Intensive Care Units; D063305:Organ Dysfunction Scores; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000175:diagnosis* / Q000628:therapy; D014481:United States
keywords: Prevention of Organ Failure Checklist; checklist; critical care; respiratory failure