Wednesday, June 29, 2011

Expanding the use of checklists

Here's an interesting paper from the American Journal of Respiratory and Critical Care Medicine:

Intervention team physicians were prompted to address six parameters from a daily rounding checklist if overlooked during morning work rounds. The second team (control) used the identical checklist without prompting...
Compared to control, prompting increased median ventilator-free duration, decreased empirical antibiotic and central venous catheter duration, and increased rates of DVT and stress ulcer prophylaxis. Prompted group patients had lower risk-adjusted ICU mortality compared to the control group (OR 0.36, 95% CI 0.13-0.96, P=0.041), and lower hospital mortality compared to the control group (10.0% vs. 20.8%, P=0.014), which remained significant after risk adjustment (odds ratio 0.34, 95% CI, 0.15-0.76, P=0.008). Observed-to-predicted ICU length of stay was lower in the prompted group compared to control (0.59 vs. 0.87, P=0.02). Checklist availability alone did not improve mortality or LOS compared to pre-intervention patients.

The lesson? It's one thing to have checklists and another to use them for all they're worth.

HT to Happy Hospitalist.

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