title: Design and α-testing of an electronic rounding tool (CERTAINp) to improve process of care in pediatric intensive care unit.
abstract: Increasing process complexity in the pediatric intensive care unit (PICU) can lead to information overload resulting in missing pertinent information and potential errors during morning rounds. An efficient model using a novel electronic rounding tool was designed as part of a broader critical care decision support system-checklist for early recognition and treatment of acute illness and injury in pediatrics (CERTAINp). We aimed to evaluate its impact on improving the process of care during rounding. Prospective pre- and post-interventional data included: team performance baseline assessment, patient safety discussion, guideline adherence, rounding time, and a survey of Residents' and Nurses' perception using a Likert scale. Attending physicians were blinded to the components of the assessment. A total of 113 pre-intervention and 114 post-intervention roundings were recorded by direct observation. Pre-intervention (108) and post-intervention staff surveys (80) were obtained. Adherence to standard of care guidelines improved to >97 % in all data points, with maximum increase seen in discussions of ulcer prophylaxis, bowel protocol, DVT prophylaxis, skin care, glucose control and head of bed elevation (2-28 % pre-vs. 100 % for all post-intervention, p < 0.01). Significant improvement was noticed in spontaneous breathing trials, sedation breaks and need for devices (45-57 % pre- vs. 100 % for all post-intervention, p < 0.01). Rounding time (mean ± SD) increased by 2 min/patient (8.0 ± 5.8 min pre-intervention vs. 9.9 ± 5.7 min post-intervention, p = 0.002). Staff reported improved perception of all aspects of rounding. Utilization of the CERTAINp rounding tool led to perfect compliance to the discussion of best practice guidelines; had minimal impact on rounding time and improved PICU staff satisfaction.
authors.affiliation: Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: Manasi
authors.initials: M
authors.lastname: Hulyalkar
authors.affiliation: Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Gleich
authors.affiliation: METRIC-Multidisciplinary Epidemiology and Translational Research in Intensive Care, Mayo Clinic, Rochester, MN, USA.
authors.forename: Rahul
authors.initials: R
authors.lastname: Kashyap
authors.affiliation: METRIC-Multidisciplinary Epidemiology and Translational Research in Intensive Care, Mayo Clinic, Rochester, MN, USA.
authors.forename: Amelia
authors.initials: A
authors.lastname: Barwise
authors.affiliation: Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: Harsheen
authors.initials: H
authors.lastname: Kaur
authors.affiliation: METRIC-Multidisciplinary Epidemiology and Translational Research in Intensive Care, Mayo Clinic, Rochester, MN, USA.
authors.forename: Yue
authors.initials: Y
authors.lastname: Dong
authors.affiliation: METRIC-Multidisciplinary Epidemiology and Translational Research in Intensive Care, Mayo Clinic, Rochester, MN, USA.
authors.forename: Lei
authors.initials: L
authors.lastname: Fan
authors.affiliation: Division of Critical Care, Department of Pediatrics, University of British Columbia, Vancouver, Canada.
authors.forename: Srinivas
authors.initials: S
authors.lastname: Murthy
authors.affiliation: Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: Grace M
authors.initials: GM
authors.lastname: Arteaga
authors.affiliation: Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA. Sandeep.tripathi@osfhealthcare.org.|Department of Pediatrics, University of Illinois College of Medicine, Peoria, IL, USA. Sandeep.tripathi@osfhealthcare.org.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Tripathi
mesh_terms: D001291:Attitude of Health Personnel; D002648:Child; D003422:Critical Care / Q000379:methods*; D004867:Equipment Design; D006801:Humans; D015278:Intensive Care Units, Pediatric; D008991:Monitoring, Physiologic / Q000379:methods*; D010349:Patient Compliance; D011446:Prospective Studies; D012815:Signal Processing, Computer-Assisted; D012984:Software; D056164:Teaching Rounds; D014584:User-Computer Interface
keywords: Electronic checklist; ICU rounds; Intensive care unit (ICU); Pediatrics