PURPOSE: Use of daily checklists during rounds in the intensive care unit (ICU) has previously been shown to improve compliance with evidence based practices, enhance physician-nurse communication, promote consistency of patient care, and improve outcomes. Checklists are often criticized because it is difficult to establish a causal link between checklists and how they exert their effects on outcomes. We sought to investigate how a daily checklist completed during multidisciplinary healthcare team (MDHCT) rounds affects discussions about patients during rounds.
METHODS: This process improvement project was conducted in a surgical ICU (SICU) and a burn ICU (BICU) at an academic military medical center. Data were collected for 2 weeks before and 2 weeks after implementation of a “must address” checklist which contained up to 21 questions grouped according to patient population. During the 2 weeks prior to implementation, a recorder documented which items were addressed during MDHCT rounds without checklist items being read out-loud. Following implementation, the recorder documented which items on the checklist were addressed during MDHCT rounds before and after prompting by reading checklist items.
RESULTS: Patient discussions addressed more checklist items before prompting at the end of the two week evaluation compared to the two week pre-implementation period (SICU 35% vs. 76%, BICU 43% vs. 71 % P<0.001). All items were addressed more or with the same frequently in both ICUs after implementation. Key items such as central line removal, reduction of laboratory testing, medical reconciliation, medication interactions, lung protective ventilation, sedation holidays and, breathing trials had significant increases.
CONCLUSIONS: Implementation of checklists in the ICU setting modifies clinician communication patterns. This is the first clear documentation of an association between checklists and communication exchange during MDHCT rounds. We suspect that improved communication about patient care plans is one mechanism behind their effectiveness.
CLINICAL IMPLICATIONS: Because they modify communication, checklists are powerful educational tools in an academic environment. It is imperative that careful consideration be given to their development so they contain appropriate questions.
DISCLOSURE: The following authors have nothing to disclose: Michelle Newkirk, Jeremy Pamplin, Roderick Kuwamoto, David Allen, Kevin Chung
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