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ICU Rounding Checklist Implementation: Effect of Accountability Measures on Physician Compliance FREE TO VIEW

Damien Patel; Keriann Van Nostrand; Anthony Cucci; Shikha Gupta; Gabriel Bosslet; William Carlos
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Indiana University School of Medicine, Indianapolis, IN

Chest. 2014;146(4_MeetingAbstracts):523A. doi:10.1378/chest.1995167
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SESSION TITLE: Quality & Clinical Improvement (Poster Discussion)

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: Daily rounding checklists (DRC) have been shown to reduce error of omission and improve patient outcomes. Previous studies have used a dedicated prompter to increase compliance with DRC. However, most institutions do not have the resources to employ a dedicated prompter. The aim of this study is to determine the impact that attending-level compliance reporting has on checklist compliance. We hypothesize that such accountability will lead to increased checklist compliance.

METHODS: We conducted a prospective study in two medical ICUs of a tertiary university system. The attending physician was given responsibility for completion of the 18-item DRC for all ICU patients from admission to ICU discharge, and three months of baseline data were collected. The intervention, consisting of presentation of attending-level checklist compliance, was then shared once monthly at the division clinical conference and electronically via email. DRC were collected and reviewed by four members of the research team. A checklist was determined to be compliant if 16 of 18 items were addressed per day. The total number of compliant days was compiled for each patient’s ICU stay. This data was used to calculate overall percent daily compliance for each attending physician.

RESULTS: In the pre-intervention phase, 907 checklists were completed out of a total 1467 checklists for a compliance of 62%. Post-intervention, 2309 checklists were completed out of a total 2741 checklists for compliance of 84%. Individual compliance improved in the intervention phase for 15/18 attendings. Analysis of the remaining attendings showed only one with decreased compliance over the study period.

CONCLUSIONS: DRC have already been proven to improve patient safety by decreasing errors of omission. Even with this knowledge, implementation and compliance of a structured checklist has proven difficult. Publishing attending compliance data appears to improve short term compliance by way of accountability.

CLINICAL IMPLICATIONS: In an era of ballooning costs institutions are looking at quality measures to improve their delivery of care whilst simultaneously reducing expenses to the health care system. Reporting physician compliance is one such simple and effective method.

DISCLOSURE: The following authors have nothing to disclose: Damien Patel, Keriann Van Nostrand, Anthony Cucci, Shikha Gupta, Gabriel Bosslet, William Carlos

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