Export Date: 28 September 2020 RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Intensive Care Units KW - Length of Stay ER - TY - JOUR TI - Checklist design and implementation: Critical considerations to improve patient safety for low-frequency, high-risk patient events AU - Turkelson, C. AU - Keiser, M. AU - Sculli, G. AU - Capoccia, D. T2 - BMJ Simulation and Technology Enhanced Learning AB - Purpose: This pilot project describes the development and implementation of two specialised aviation-style checklist designs for a low-frequency high-risk patient population in a cardiac intensive care unit. The effect of the checklist design as well as the implementation strategies on patient outcomes and adherence to best practice guidelines were also explored. The long-term objective was to improve adherence to accepted processes of care by establishing the checklists as standard practice thereby improving patient safety and outcomes. Methods: During this project, 10specialised crisis checklists using two specific aviation-style designs were developed. A quasiexperimental prospective pre-post repeated measure design including surveys along with repetitive simulations were used to evaluate self-confidence and self-efficacy over time as well as the perceived utility, ease of use, fit into workflow and benefits of the checklists use to patients. Performance, patient outcomes and manikin outcomes were also used to evaluate the effectiveness of the crisis checklists on provider behaviours and patient outcomes. Results: Overall self-confidence and self-confidence related to skills and knowledge while not significant demonstrated clinically relevant improvements that were sustained over time. Perceptions of the checklists were positive with consistent utilisation sustained over time. More importantly, use of the checklists demonstrated a reduction in errors both in the simulated and clinical setting. Conclusion: Recommendations from this study consist of key considerations for development and implementation of checklists including: utilisation of stakeholders in the development phase; implementation in real and simulated environments; and ongoing reinforcement and training to sustain use. © Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ. DA - 2020/// PY - 2020 VL - 6 IS - 3 SP - 148 EP - 157 UR - https://www.scopus.com/inward/record.uri?eid=2-s2.0-85084432977&doi=10.1136%2fbmjstel-2018-000353&partnerID=40&md5=14b1c81b1bcc67d4dc632d1cf6f47d5f AN - rayyan-105238279 N1 -Export Date: 28 September 2020 RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
ER - TY - JOUR TI - Improving end-of-rotation transitions of care among ICU patients AU - Denson, J.L. AU - Knoeckel, J. AU - Kjerengtroen, S. AU - Johnson, R. AU - McNair, B. AU - Thornton, O. AU - Douglas, I.S. AU - Wechsler, M.E. AU - Burke, R.E. T2 - BMJ Quality and Safety AB - Background Hospitalised patients whose inpatient teams rotate off service experience increased mortality related to end-of-rotation care transitions, yet standardised handoff practices are lacking. Objective Develop and implement a multidisciplinary patient-centred handoff intervention to improve outcomes for patients who are critically ill during end-of-rotation transitions. Design, setting and participants Single-centre, controlled pilot study of medical intensive care unit (ICU) patients whose resident team was undergoing end-of-rotation transition at a university hospital from June 2017 to February 2018. Intervention A 4-item intervention was implemented over two study periods. Intervention 1 included: (1) in-person bedside handoff between teams rotating off and on service, (2) handoff checklist, (3) nursing involvement in handoff, and (4) 30 min education session. Intervention 2 included the additional option to conduct bedside handoff via videoconferencing. Main outcome measures Implementation was measured by repeated clinician surveys and direct observation. Patient outcomes included length of stay (LOS; ICU and hospital) and mortality (ICU, hospital and 30 days). Clinician perceptions were modelled over time using per cent positive responses in logistic regression. Patient outcomes were compared with matched control 'transition' patients from 1 year prior to implementation of the intervention. Results Among 270 transition patients, 46.3% were female with a mean age of 55.9 years. Mechanical ventilation (64.1%) and in-hospital death (27.6%) rates were prevalent. Despite high implementation rates - handoff participation (93.8%), checklist utilisation (75.0%), videoconferencing (62.5%), nursing involvement (75.0%) - the intervention did not significantly improve LOS or mortality. Multidisciplinary survey data revealed significant improvement in acceptability by nursing staff, while satisfaction significantly declined for resident physicians. Conclusions In this controlled pilot study, a structured ICU end-of-rotation care transition strategy was feasible to implement with high fidelity. While mortality and LOS were not affected in a pilot study with limited power, the pragmatic strategy of this intervention holds promise for future trials. © Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ. DA - 2020/// PY - 2020 VL - 29 IS - 3 SP - 250 EP - 259 UR - https://www.scopus.com/inward/record.uri?eid=2-s2.0-85074868113&doi=10.1136%2fbmjqs-2019-009867&partnerID=40&md5=0f41a513f058988aa4696f8ca259c124 AN - rayyan-105238282 N1 -Export Date: 28 September 2020 RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Rotation ER - TY - JOUR TI - Retrospective study of security in the transfer of critical patients after application of methodology for risk management AU - Nespereira García, P. AU - Cabadas Avión, R. AU - Leal Ruiloba, M.S. AU - Rodríguez Pérez, J. AU - Broullón Dobarro, A. AU - Rivero García, A. T2 - Revista Espanola de Anestesiologia y Reanimacion AB - Objective: The main objective of our study is to determine if the implementation of an HIT protocol modifies the annual rate of incidents related to patient safety. The secondary objectives are, firstly, to classify the identified events, secondly to analyze the factors that are associated with the presence of said adverse events and finally to analyze the degree of monitoring of the protocol. Material and methods: Retrospective descriptive analysis that included patients admitted to the Intensive Care Unit who required HIT between 2009 and 2018. A multidisciplinary protocol was developed and the incidents were classified according to the severity and type of events. Results: We included 1662 transfers. The total number of transfers with incidents was 153 (9.2%) in which 189 incidents were registered, of which 17 (9%) were described as adverse events (AD), while 172 (91%) were classified as Incidents without Damage (IsD). The clinical incidents were the most frequent (70.37%). In the multivariate analysis we found as associated factors cardiac arrhythmias (OR: 2.88 [IQR 2.01-4.12]), history of stroke (OR 1.72 [IQR 1.06-2.78]) and anemia (OR 1.55 [IQR 1.02-2.37]) The rate of safety-related incidents was less over time as adherence to protocol compliance increased. Conclusions: The implementation of a critical patient transport protocol and its application through checklists allows to reduce both the incidence of adverse events in these patients and of Incidents without Damage. © 2019 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor DA - 2020/// PY - 2020 VL - 67 IS - 3 SP - 119 EP - 129 UR - https://www.scopus.com/inward/record.uri?eid=2-s2.0-85076530410&doi=10.1016%2fj.redar.2019.10.003&partnerID=40&md5=290c10239eae76bc0d023dab3403aed8 AN - rayyan-105238283 N1 -Export Date: 28 September 2020 RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Retrospective Studies KW - Risk Management ER - TY - JOUR TI - Incidents related to critical patient safety during in-hospital transfer AU - Catalán-Ibars, R.M. AU - Martín-Delgado, M.C. AU - Puigoriol-Juvanteny, E. AU - Zapater-Casanova, E. AU - Lopez-Alabern, M. AU - Lopera-Caballero, J.L. AU - González de Velasco, J.P. AU - Coll-Solà, M. AU - Juanola-Codina, M. AU - Roger-Casals, N. T2 - Medicina Intensiva AB - Objective: To analyze the incidents related to patient safety (IRSP) and their risk factors during in-hospital transfer (IHT) of critical patients after the application of a protocol, and to evaluate safety during transfer using quality indicators. Design: A prospective, observational and non-intervention cohort study was carried out. Setting: A 10-bed multipurpose Intensive Care Unit (ICU) of a second level university hospital. Patients: All IHTs of critical patients in the ICU for diagnostic tests and to the operating room between March 2011 and March 2017 were included in the study. Main measurements: Demographic variables, patient severity, transfer priority, moment of the day, reason and type of transfer team. Pre-transport checklist items and IRSP were collected. A biannual analysis was made of quality indicators designed for IHT. Results: A total of 805 transfers were registered, mostly of an urgent nature (53.7%) and for diagnostic tests (77%). In turn, 112 transfers (13.9%) presented some type of IRSP; 54% related to the equipment and 30% related to team and organization. Adverse events occurred in 19 (2.4%) transfers. Risk factors identified in the multivariate analysis were mechanical ventilation and the transport team. The evolution of the indicators related to transport was significantly favorable. Conclusions: After the application of an IHT protocol, IRSP are low. The main risk factor is invasive mechanical ventilation. The experience of the team performing IHT influences the detection of a greater number of incidents. © 2020 Elsevier España, S.L.U. y SEMICYUC DA - 2020/// PY - 2020 UR - https://www.scopus.com/inward/record.uri?eid=2-s2.0-85087990517&doi=10.1016%2fj.medin.2020.05.022&partnerID=40&md5=548f8a68e4be7013a06ae89cf60e3483 AN - rayyan-105238289 N1 -Export Date: 28 September 2020 RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
ER - TY - JOUR TI - Auditing of enteral nutrition nursing care in critical care patients AU - Al-Jalil, T. AU - Gray, G. AU - Rasouli, M. AU - Hoseini-Azizi, T. AU - Hejazi, S.-S. T2 - Nursing Practice Today AB - Background & Aim: Enteral nutrition standards noncompliance is one of the factors that threatens patient safety. Auditing is an important part in quality improvement processes. The aim of this study was to determine enteral nutrition nursing care conformity rate with standards in the critical care units. Methods & Materials: In this descriptive study, 400 enteral feeding nursing care were assessed via time and event sampling methods. The tool was a researcher made check list in three fields: pre-feeding, feeding, and post feeding nursing care. Content validity and inter-rater coefficient reliability were calculated for checklist. The obtained data were analyzed using descriptive statistics. Results: The most conformity rate with standards was in feeding (86%), pre-feeding (3/8 %) and post feeding (2/3%) field, respectively. Determination of PH (100%) and accurate gastric residual volume (99.8%) in pre-feeding field, disconnection of the syringe from catheter after feeding, in feeding filed and accurate documentation of the care (99.3%) in post feeding field, were not implemented in the most of cases. Conclusion: Enteral nutrition nursing care is far from standards in the pre and post feeding fields. Lack of the clear clinical guidelines, shortage of nursing staff and equipment and inadequate training are relating factors. © 2019, Tehran University of Medical Sciences. All rights reserved. DA - 2019/// PY - 2019 VL - 6 IS - 1 SP - 18 EP - 25 UR - https://www.scopus.com/inward/record.uri?eid=2-s2.0-85067354795&doi=10.18502%2fnpt.v6i1.389&partnerID=40&md5=af8fae7c567cbd29f4593617b027b47f AN - rayyan-105238291 N1 -Export Date: 28 September 2020 RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Critical Care ER - TY - JOUR TI - A tiered approach for preventing central line-associated bloodstream infection AU - Patel, P.K. AU - Olmsted, R.N. AU - Hung, L. AU - Popovich, K.J. AU - Meddings, J. AU - Jones, K. AU - Calfee, D.P. AU - Fowler, K.E. AU - Saint, S. AU - Chopra, V. T2 - Annals of Internal Medicine DA - 2019/// PY - 2019 VL - 171 IS - 7 SP - S16 EP - S22 UR - https://www.scopus.com/inward/record.uri?eid=2-s2.0-85072760201&doi=10.7326%2fM18-3469&partnerID=40&md5=defc7c7d87d8fd90ac7a5405332909fe AN - rayyan-105238293 N1 -Cited By :3 Export Date: 28 September 2020 RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
ER - TY - JOUR TI - The feasibility study of a revised standard care procedure on the capacity of nasogastric tube placement verification among critical care nurses AU - Yang, F.-H. AU - Lin, F.-Y. AU - Hwu, Y.-J. T2 - Journal of Nursing Research AB - Background: Evidence-based studies propose that the aspirate pH test may be easily and reliably conducted to verify the proper placement of nasogastric tubes (NGTs). Nurses rarely implement this procedure because of the lack of related knowledge. Purpose: The purpose of this study was to explore the feasibility of implementing a revised standard care procedure to enhance nurses' ability to verify placement of the NGT. Methods: his study used a quasi-experimental, longitudinal research design. Nurses from two intensive care units were randomly assigned to the experimental group (n = 35) and the control group (n = 31). A revised standard-of-care procedure to confirm the proper placement of an NGT was incorporated into a slideshow presentation, a printed leaflet, and an audit checklist. The experimental group received continuous education and individual teaching on the revised standard-of-care procedure, whereas the control group did not receive additional education and continued to provide conventional care. The study gathered data using scales designed to address knowledge of and attitudes toward verification of NGT placement and the checklist for auditing the NGT care procedure. Scales were implemented before and after the practice program was conducted, in Months 1, 2, and 3, to evaluate the feasibility of the developed improvement measures. Results: This study found significant improvements in the experimental group in terms of knowledge regarding NGT placement verification and the NGT care auditing procedure. The positive improvement of the intervention on the NGT care auditing procedure remained for at least 3 months after the end of the intervention. Conclusions: The findings suggest that using an aspirate pH test is a feasible approach to verify NGT placement in critical care units, a crucial aspect of care necessary to promote patient safety and quality of care. Copyright © 2019 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved. DA - 2019/// PY - 2019 VL - 27 IS - 4 UR - https://www.scopus.com/inward/record.uri?eid=2-s2.0-85069775816&doi=10.1097%2fjnr.0000000000000302&partnerID=40&md5=49b97266c8bfd19c5a6ce63cf754365f AN - rayyan-105238294 N1 -Export Date: 28 September 2020 RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Feasibility Studies ER - TY - JOUR TI - Emergency management in the heart catheter laboratory: When intensive care physicians meet cardiologists AU - Michels, G. AU - Adler, C. AU - Reuter, H. AU - Pfister, R. T2 - Medizinische Klinik - Intensivmedizin und Notfallmedizin AB - The establishment of primary percutaneous interventions for the treatment of myocardial infarction, increasingly complex coronary and noncoronary interventions in severely ill patients, and the increasing rise in the number of catheter examinations in elderly and morbid patients due to demographics frequently necessitates involvement of intensive care physicians for primary care of unstable patients and management of complications within the cath lab. In the context of complication and risk management, therefore, all cardiac catheter labs should develop a checklist in collaboration with the respective emergency/intensive care team. Team-oriented interdisciplinary management through standardization of emergency scenarios remains the key to success, despite all progress. © 2017, Springer Medizin Verlag GmbH. DA - 2019/// PY - 2019 VL - 114 IS - 1 SP - 4 EP - 8 UR - https://www.scopus.com/inward/record.uri?eid=2-s2.0-85017105435&partnerID=40&md5=78ff59602c7d96f5defa5a887caf81c9 AN - rayyan-105238308 N1 -Cited By :1 Export Date: 28 September 2020 RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Emergencies ER - TY - JOUR TI - Measures to prevent medication errors in intensive care units AU - Plutínská, Z. AU - Plevová, I. T2 - Central European Journal of Nursing and Midwifery AB - Aim: The aims were to summarize studies on the effectiveness of interventions to reduce adverse events of the medication error type and, based on the studies, to identify recommendations for preventing medication errors in intensive care units (ICUs). Design: A descriptive review. Methods: To find relevant resources, the SCOPUS and EBSCO electronic databases were searched using the following search words: prevention, medication errors, intensive care unit. Both primary and secondary studies on prevention of medication errors in ICUs were selected. Results: A total of eight primary studies and three systematic reviews were included. The studies showed considerable variability and differed in methods, numbers of monitored events or ways of data collection. The assessed interventions were pharmacist involvement, automated infusion devices, reporting medication errors, strategies to limit interruptions during drug administration, electronic health records together with support systems for clinical decision making, nurse education in drug administration and creating checklists. Conclusion: The assessment of selected studies suggests that to a certain extent, all of them showed certain medication error reduction. Due to numerous limitations, however, it is impossible to select and recommend a single approach. © 2019 Central European Journal of Nursing and Midwifery DA - 2019/// PY - 2019 VL - 10 IS - 2 SP - 1059 EP - 1067 UR - https://www.scopus.com/inward/record.uri?eid=2-s2.0-85068862959&doi=10.15452%2fCEJNM.2019.10.0014&partnerID=40&md5=b2fc5ed47fcdf888aec9b5be3a1fb34b AN - rayyan-105238309 N1 -Export Date: 28 September 2020 RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Intensive Care Units KW - Medical Errors KW - Medication Errors ER - TY - JOUR TI - Improving transitions of care between the operating room and intensive care unit AU - Wheeler, D.S. AU - Sheets, A.M. AU - Ryckman, F.C. T2 - Translational Pediatrics AB - Transitions of care between individual providers or teams of providers have a high potential for errors due to the incomplete transfer of critical information and the need for ongoing care. The transition from the operating room (OR) to the intensive care unit (ICU) is a particularly dangerous time for critically ill children. Hand-offs of care between the OR and ICU teams during this key transition period require detailed communication of complete and accurate patient information at a time when the patient is perhaps most vulnerable from a physiologic standpoint. Improving the safety of transitions from the OR to the ICU is an active area of investigation, though there are a few notable best practices that are commonly employed in a number of centers. These best practices include having the appropriate personnel at the bedside for the hand-off, the use of scripts and the “sterile cockpit rule”, the use of checklists, double verification of postoperative orders, and maintaining an overall safety culture. © Translational Pediatrics. All rights reserved. DA - 2018/// PY - 2018 VL - 7 IS - 4 SP - 299 EP - 307 UR - https://www.scopus.com/inward/record.uri?eid=2-s2.0-85056721086&doi=10.21037%2ftp.2018.09.09&partnerID=40&md5=afee9951dd82de2383da0cba4220764b AN - rayyan-105238317 N1 -Cited By :1 Export Date: 28 September 2020 RAYYAN-INCLUSION: {"Victor Hugo"=>"Included"}
KW - Intensive Care Units ER - TY - JOUR TI - Improving communication of patient issues on transfer out of intensive care AU - Roberts, J.C. AU - Johnston-Walker, L. AU - Parker, K. AU - Townend, K. AU - Bickley, J. T2 - BMJ Open Quality AB - The written medical handover document is frequently poor in quality and highly variable which raises concerns about patient safety. Intensive care unit (ICU) patients have complex medical and social issues which increases the risk of errors during ongoing hospital treatment. Our project team of four doctors and two nurses aimed to improve the documentation of patient problems as they leave the ICU. A literature review and process mapping of both medical and nursing transfer documentation helped in understanding the current process. Current problems (CP) were defined as any patient issues which require ongoing thought, management or follow-up. Our progress was tracked using a measure of the number of CPs listed in the free-text field titled 'Current Problems' in 50 medical transfer documents. This was graphed on a control chart showing a process in statistical control. Means and control limits were recalculated whenever a process shift occurred. There was no relationship between the number of CPs listed and length of ICU stay, age of patient, or severity of illness on presentation (Acute Physiologic Assessment and Chronic Health Evaluation II score). An inter-relationship graph identified the key drivers which were amenable to change: (1) the doctors completing the clinical summary at the time of discharge did not have all the information readily available to them and (2) the doctors were uncertain of the types of problem which should be communicated. Improvements were designed and trialled using Plan-Do-Study-Act cycles to address these two key drivers. At baseline, the average number of CPs per patient was 1.8. After implementation of a paper problem list at the patient bedside, with supporting education, the average increased to 2.7. This was further improved by the addition of a checklist of common patient problems. This increased the average to 3.85. These improvements were permanently implemented and ongoing audits have shown sustained improvement using statistical process control methods. © Author(s) (or their employer(s)) 2018. DA - 2018/// PY - 2018 VL - 7 IS - 4 UR - https://www.scopus.com/inward/record.uri?eid=2-s2.0-85081014872&doi=10.1136%2fbmjoq-2018-000385&partnerID=40&md5=8086d0cff34b05d62dd34c3d19909b55 AN - rayyan-105238318 N1 -Cited By :1 Export Date: 28 September 2020 RAYYAN-INCLUSION: {"Victor Hugo"=>"Included"}
ER - TY - JOUR TI - A change to the surgical safety checklist to reduce patient identification errors AU - Pysyk, C.L. T2 - Canadian Journal of Anesthesia DA - 2018/// PY - 2018 VL - 65 IS - 2 SP - 219 EP - 220 UR - https://www.scopus.com/inward/record.uri?eid=2-s2.0-85032931948&doi=10.1007%2fs12630-017-0997-7&partnerID=40&md5=ace39923a04476a6a0a0dfcadbfdb2ec AN - rayyan-105238324 N1 -Cited By :2 Export Date: 28 September 2020 RAYYAN-INCLUSION: {"Victor Hugo"=>"Included"}
ER - TY - JOUR TI - Interruptions in intensive care nursing shift handovers: Patient safety implications AU - de Oliveira, J.G.A.D. AU - de Almeida, L.F. AU - Hirabae, L.F.A. AU - de Andrade, K.B.S. AU - Sá, C.M.S. AU - de Paula, V.G. T2 - Revista Enfermagem AB - Objective: To identify factors intervening during shift handovers in an intensive care unit. Method: This cross-sectional, descriptive, observational, quantitative study of 522 shift handovers among nursing personnel was conducted at an intensive care unit of a university hospital in the municipality of Rio de Janeiro, between February and June 2017. Data were collected by observation and recording by researchers using a checklist for the main factors that may interfere with shift changes, and were analyzed by simple descriptive statistics. The study was approved by the research ethics committee. Results: The factors most observed were: Alarms ringing (79.6%), parallel conversations (19.3%), and quiet voice of the professional handing over the shift (11.1%). Conclusion: The intervening factors identified were considered to be factors impairing effective communication between the nursing team and aggravating risks to patient safety. © 2018, Centro de Estudos da Faculdade de Enfermagem da UERJ. All rights reserved. DA - 2018/// PY - 2018 VL - 26 UR - https://www.scopus.com/inward/record.uri?eid=2-s2.0-85073293506&doi=10.12957%2freuerj.2018.33877&partnerID=40&md5=7ea88b4e2808111a13b889d54643bbe8 AN - rayyan-105238330 N1 -Cited By :1 Export Date: 28 September 2020 RAYYAN-INCLUSION: {"Victor Hugo"=>"Included"}
ER - TY - JOUR TI - Relationship between Psychological Safety and Reporting Nonadherence to a Safety Checklist AU - Gilmartin, H.M. AU - Langner, P. AU - Gokhale, M. AU - Osatuke, K. AU - Hasselbeck, R. AU - Maddox, T.M. AU - Battaglia, C. T2 - Journal of Nursing Care Quality AB - Patient safety checklists are ubiquitous in health care. Nurses bear significant responsibility for ensuring checklist adherence. To report nonadherence to a checklist and stop an unsafe procedure, a workplace climate of psychological safety is needed. Thus, an analysis of organizational data was conducted to examine the relationship between psychological safety and reports of nonadherence to the central line bundle checklist. Results showed varied perceptions of psychological safety but no relationship with nonadherence. Considerations for this finding and assessing psychological safety are provided. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved. DA - 2018/// PY - 2018 VL - 33 IS - 1 SP - 53 EP - 60 UR - https://www.scopus.com/inward/record.uri?eid=2-s2.0-85037740226&doi=10.1097%2fNCQ.0000000000000265&partnerID=40&md5=d464d7f40fd216669f7e00c57e4f914e AN - rayyan-105238331 N1 -Cited By :6 Export Date: 28 September 2020 RAYYAN-INCLUSION: {"Victor Hugo"=>"Included"}
ER - TY - JOUR TI - Handovers among staff intensivists: A study of information loss and clinical accuracy to anticipate events AU - Dutra, M. AU - Monteiro, M.V. AU - Ribeiro, K.B. AU - Schettino, G.P. AU - Amaral, A.C.K.-B. T2 - Critical Care Medicine AB - Objectives: Handovers are associated with medical errors, and our primary objective is to identify missed diagnosis and goals immediately after a shift handover. Our secondary objective is to assess clinicians' diagnostic accuracy in anticipating clinical events during the night shift. Design: Single-center prospective observational cohort study. Setting: Thirty-bed tertiary ICU in Sao Paulo, Brazil. Patients: Three-hundred ffty-two patient encounters over 44 dayto-night handovers. Interventions: None. Measurements and Main Results: We used a multimethods approach to measure transmission of information among staff physicians on diagnoses and goals for the night shift. We surveyed clinicians immediately after a handover and identifed clinical events through chart abstractions and interviews with clinicians the next morning. Nighttime clinicians correctly identifed 454 of 857 diagnoses (53%; 95% CI 50-56) and 123 of 304 goals (40%; 95% CI, 35-46). Daytime clinicians were more sensitive (65% vs 46%; p < 0.01) but less specifc (82% vs 91%; p < 0.01) than nighttime clinicians in anticipating clinical events at night, resulting in similar accuracy (area under the receiver operating characteristic curve, 0.74 [95% CI, 0.68-0.79] vs 0.68 [95% CI 0.63-0.74]; p = 0.09). The positive predictive value of both daytime and nighttime clinicians was low (13% vs 17%; p = 0.2). Gaps in diagnosis and anticipation of events were more pronounced in neurologic diagnoses. Conclusions: Among staff intensivists, diagnoses and goals of treatment are either not conveyed or retained 50-60% of the cases immediately after a handover. Clinicians have limited ability to anticipate events, and the expectation that anticipatory guidance can inform handovers needs to be balanced against information overload. Handovers among staff intensivists showed more gaps in the identifcation of diagnostic uncertainty and for neurologic diagnoses, which could beneft from communication strategies such as cognitive checklists, prioritizing discussion of neurologic patients, and brief combined clinical examination at handover. © 2018 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved. DA - 2018/// PY - 2018 VL - 46 IS - 11 SP - 1717 EP - 1721 UR - https://www.scopus.com/inward/record.uri?eid=2-s2.0-85054893127&doi=10.1097%2fCCM.0000000000003320&partnerID=40&md5=1f12fb1b4efa16ab069aece0310e8e4e AN - rayyan-105238332 N1 -Cited By :4 Export Date: 28 September 2020 RAYYAN-INCLUSION: {"Victor Hugo"=>"Included"}
ER - TY - JOUR TI - More Than a Tick Box: Medical Checklist Development, Design, and Use AU - Burian, B.K. AU - Clebone, A. AU - Dismukes, K. AU - Ruskin, K.J. T2 - Anesthesia and Analgesia AB - Despite improving patient safety in some perioperative settings, some checklists are not living up to their potential and complaints of "checklist fatigue" and outright rejection of checklists are growing. Problems reported often concern human factors: poor design, inadequate introduction and training, duplication with other safety checks, poor integration with existing workflow, and cultural barriers. Each medical setting - such as an operating room or a critical care unit - and different clinical needs - such as a shift handover or critical event response - require a different checklist design. One size will not fit all, and checklists must be built around the structure of medical teams and the flow of their work in those settings. Useful guidance can be found in the literature; however, to date, no integrated and comprehensive framework exists to guide development and design of checklists to be effective and harmonious with the flow of medical and perioperative tasks. We propose such a framework organized around the 5 stages of the checklist life cycle: (1) conception, (2) determination of content and design, (3) testing and validation, (4) induction, training, and implementation, and (5) ongoing evaluation, revision, and possible retirement. We also illustrate one way in which the design of checklists can better match user needs in specific perioperative settings (in this case, the operating room during critical events). Medical checklists will only live up to their potential to improve the quality of patient care if their development is improved and their designs are tailored to the specific needs of the users and the environments in which they are used. © 2017 International Anesthesia Research Society. DA - 2018/// PY - 2018 VL - 126 IS - 1 SP - 223 EP - 232 UR - https://www.scopus.com/inward/record.uri?eid=2-s2.0-85038378279&doi=10.1213%2fANE.0000000000002286&partnerID=40&md5=712897eff82c9b9e4919f1bc1869f241 AN - rayyan-105238334 N1 -Cited By :30 Export Date: 28 September 2020 RAYYAN-INCLUSION: {"Victor Hugo"=>"Included"}
KW - Ticks ER - TY - JOUR TI - Clinical Practice Guideline: Safe Medication Use in the ICU AU - Kane-Gill, S.L. AU - Dasta, J.F. AU - Buckley, M.S. AU - Devabhakthuni, S. AU - Liu, M. AU - Cohen, H. AU - George, E.L. AU - Pohlman, A.S. AU - Agarwal, S. AU - Henneman, E.A. AU - Bejian, S.M. AU - Berenholtz, S.M. AU - Pepin, J.L. AU - Scanlon, M.C. AU - Smith, B.S. T2 - Critical Care Medicine AB - Objective: To provide ICU clinicians with evidence-based guidance on safe medication use practices for the critically ill. Data Sources: PubMed, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, CINAHL, Scopus, and ISI Web of Science for relevant material to December 2015. Study Selection: Based on three key components: 1) environment and patients, 2) the medication use process, and 3) the patient safety surveillance system. The committee collectively developed Population, Intervention, Comparator, Outcome questions and quality of evidence statements pertaining to medication errors and adverse drug events addressing the key components. A total of 34 Population, Intervention, Comparator, Outcome questions, five quality of evidence statements, and one commentary on disclosure was developed. Data Extraction: Subcommittee members were assigned selected Population, Intervention, Comparator, Outcome questions or quality of evidence statements. Subcommittee members completed their Grading of Recommendations Assessment, Development, and Evaluation of the question with his/her quality of evidence assessment and proposed strength of recommendation, then the draft was reviewed by the relevant subcommittee. The subcommittee collectively reviewed the evidence profiles for each question they developed. After the draft was discussed and approved by the entire committee, then the document was circulated among all members for voting on the quality of evidence and strength of recommendation. Data Synthesis: The committee followed the principles of the Grading of Recommendations Assessment, Development, and Evaluation system to determine quality of evidence and strength of recommendations. Conclusions: This guideline evaluates the ICU environment as a risk for medication-related events and the environmental changes that are possible to improve safe medication use. Prevention strategies for medication-related events are reviewed by medication use process node (prescribing, distribution, administration, monitoring). Detailed considerations to an active surveillance system that includes reporting, identification, and evaluation are discussed. Also, highlighted is the need for future research for safe medication practices that is specific to critically ill patients. © 2017 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved. DA - 2017/// PY - 2017 VL - 45 IS - 9 SP - e877 EP - e915 UR - https://www.scopus.com/inward/record.uri?eid=2-s2.0-85032380590&doi=10.1097%2fCCM.0000000000002533&partnerID=40&md5=9a68c0d9ffd268b8cf5c6766f149f39a AN - rayyan-105238345 N1 -Cited By :29 Export Date: 28 September 2020 RAYYAN-INCLUSION: {"Victor Hugo"=>"Included"}
ER - TY - JOUR TI - Prospective evaluation of a multifaceted intervention to improve outcomes in intensive care: The promoting respect and ongoing safety through patient engagement communication and technology study AU - Dykes, P.C. AU - Rozenblum, R. AU - Dalal, A. AU - Massaro, A. AU - Chang, F. AU - Clements, M. AU - Collins, S. AU - Donze, J. AU - Fagan, M. AU - Gazarian, P. AU - Hanna, J. AU - Lehmann, L. AU - Leone, K. AU - Lipsitz, S. AU - McNally, K. AU - Morrison, C. AU - Samal, L. AU - Mlaver, E. AU - Schnock, K. AU - Stade, D. AU - Williams, D. AU - Yoon, C. AU - Bates, D.W. T2 - Critical Care Medicine AB - Objectives: Studies comprehensively assessing interventions to improve team communication and to engage patients and care partners in ICUs are lacking. This study examines the effectiveness of a patient-centered care and engagement program in the medical ICU. Design: Prospective intervention study. Setting: Medical ICUs at large tertiary care center. Patients: Two thousand one hundred five patient admissions (1,030 before and 1,075 during the intervention) from July 2013 to May 2014 and July 2014 to May 2015. Interventions: Structured patient-centered care and engagement training program and web-based technology including ICU safety checklist, tools to develop shared care plan, and messaging platform. Patient and care partner access to online portal to view health information, participate in the care plan, and communicate with providers. Measurements and Main Results: Primary outcome was aggregate adverse event rate. Secondary outcomes included patient and care partner satisfaction, care plan concordance, and resource utilization. We included 2,105 patient admissions, (1,030 baseline and 1,075 during intervention periods). The aggregate rate of adverse events fell 29%, from 59.0 per 1,000 patient days (95% CI, 51.8-67.2) to 41.9 per 1,000 patient days (95% CI, 36.3-48.3; p < 0.001), during the intervention period. Satisfaction improved markedly from an overall hospital rating of 71.8 (95% CI, 61.1-82.6) to 93.3 (95% CI, 88.2-98.4; p < 0.001) for patients and from 84.3 (95% CI, 81.3-87.3) to 90.0 (95% CI, 88.1-91.9; p < 0.001) for care partners. No change in care plan concordance or resource utilization. Conclusions: Implementation of a structured team communication and patient engagement program in the ICU was associated with a reduction in adverse events and improved patient and care partner satisfaction. Copyright © 2017 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved. DA - 2017/// PY - 2017 VL - 45 IS - 8 SP - e806 EP - e813 UR - https://www.scopus.com/inward/record.uri?eid=2-s2.0-85023777232&doi=10.1097%2fCCM.0000000000002449&partnerID=40&md5=258962fb8a6b7766ed579c6780c4938c AN - rayyan-105238349 N1 -Cited By :23 Export Date: 28 September 2020 RAYYAN-INCLUSION: {"Victor Hugo"=>"Included"}
ER - TY - JOUR TI - The ABCDEF bundle: Science and philosophy of how ICU liberation serves patients and families AU - Ely, E.W. T2 - Critical Care Medicine AB - Over the past 20 years, critical care has matured in a myriad of ways resulting in dramatically higher survival rates for our sickest patients. For millions of new survivors comes de novo suffering and disability called "the postintensive care syndrome." Patients with postintensive care syndrome are robbed of their normal cognitive, emotional, and physical capacity and cannot resume their previous life. The ICU Liberation Collaborative is a real-world quality improvement initiative being implemented across 76 ICUs designed to engage strategically the ABCDEF bundle through team- and evidence-based care. This article explains the science and philosophy of liberating ICU patients and families from harm that is both inherent to critical illness and iatrogenic. ICU liberation is an extensive program designed to facilitate the implementation of the pain, agitation, and delirium guidelines using the evidence-based ABCDEF bundle. Participating ICU teams adapt data from hundreds of peer-reviewed studies to operationalize a systematic and reliable methodology that shifts ICU culture from the harmful inertia of sedation and restraints to an animated ICU filled with patients who are awake, cognitively engaged, and mobile with family members engaged as partners with the ICU team at the bedside. In doing so, patients are "liberated" from iatrogenic aspects of care that threaten his or her sense of self-worth and human dignity. The goal of this 2017 plenary lecture at the 47th Society of Critical Care Medicine Congress is to provide clinical ICU teams a synthesis of the literature that led to the creation of ICU liberation philosophy and to explain how this patient- and family-centered, quality improvement program is novel, generalizable, and practice changing. © 2017 Society of Critical Care Medicine and Wolters Kluwer Health, Inc. DA - 2017/// PY - 2017 VL - 45 IS - 2 SP - 321 EP - 330 UR - https://www.scopus.com/inward/record.uri?eid=2-s2.0-85009804127&doi=10.1097%2fCCM.0000000000002175&partnerID=40&md5=16716d8cca2d412f5491ce392f03f5d7 AN - rayyan-105238357 N1 -Cited By :88 Export Date: 28 September 2020 RAYYAN-INCLUSION: {"Victor Hugo"=>"Included"}
ER - TY - JOUR TI - Lost information during the handover of critically injured trauma patients: A mixed-methods study AU - Zakrison, T.L. AU - Rosenbloom, B. AU - McFarlan, A. AU - Jovicic, A. AU - Soklaridis, S. AU - Allen, C. AU - Schulman, C. AU - Namias, N. AU - Rizoli, S. T2 - BMJ Quality and Safety AB - Background Clinical information may be lost during the transfer of critically injured trauma patients from the emergency department (ED) to the intensive care unit (ICU). The aim of this study was to investigate the causes and frequency of information discrepancies with handover and to explore solutions to improving information transfer. Methods A mixed-methods research approach was used at our level I trauma centre. Information discrepancies between the ED and the ICU were measured using chart audits. Descriptive, parametric and non-parametric statistics were applied, as appropriate. Six focus groups of 46 ED and ICU nurses and nine individual interviews of trauma team leaders were conducted to explore solutions to improve information transfer using thematic analysis. Results Chart audits demonstrated that injuries were missed in 24% of patients. Clinical information discrepancies occurred in 48% of patients. Patients with these discrepancies were more likely to have unknown medical histories (p<0.001) requiring information rescue (p<0.005). Close to one in three patients with information rescue had a change in clinical management (p<0.01). Participants identified challenges according to their disciplines, with some overlap. Physicians, in contrast to nurses, were perceived as less aware of interdisciplinary stress and their role regarding variability in handover. Standardising handover, increasing non-technical physician training and understanding unit cultures were proposed as solutions, with nurses as drivers of a culture of safety. Conclusion Trauma patient information was lost during handover from the ED to the ICU for multiple reasons. An interprofessional approach was proposed to improve handover through cross-unit familiarisation and use of communication tools is proposed. Going beyond traditional geographical and temporal boundaries was deemed important for improving patient safety during the ED to ICU handover. © Published by the BMJ Publishing Group Limited. DA - 2016/// PY - 2016 VL - 25 IS - 12 SP - 929 EP - 936 UR - https://www.scopus.com/inward/record.uri?eid=2-s2.0-85001960804&doi=10.1136%2fbmjqs-2014-003903&partnerID=40&md5=f4b8dbc922a045ebaa93b1cd7ceb59f5 AN - rayyan-105238364 N1 -Cited By :17 Export Date: 28 September 2020 RAYYAN-INCLUSION: {"Victor Hugo"=>"Included"}
ER - TY - JOUR TI - Effect of a quality improvement intervention with daily round checklists, goal setting, and clinician prompting on mortality of critically ill patients: A randomized clinical trial AU - Cavalcanti, A.B. AU - Bozza, F.A. AU - Machado, F.R. AU - Salluh, J.I.F. AU - Campagnucci, V.P. AU - Vendramim, P. AU - Guimaraes, H.P. AU - Normilio-Silva, K. AU - Damiani, L.P. AU - Romano, E. AU - Carrara, F. AU - De Souza, J.L.D. AU - Silva, A.R. AU - Ramos, G.V. AU - Teixeira, C. AU - Da Silva, N.B. AU - Chang, C.-C.H. AU - Angus, D.C. AU - Berwanger, O. T2 - JAMA - Journal of the American Medical Association AB - IMPORTANCE: The effectiveness of checklists, daily goal assessments, and clinician prompts as quality improvement interventions in intensive care units (ICUs) is uncertain. OBJECTIVE: To determine whether a multifaceted quality improvement intervention reduces the mortality of critically ill adults. DESIGN, SETTING, AND PARTICIPANTS: This study had 2 phases. Phase 1 was an observational study to assess baseline data on work climate, care processes, and clinical outcomes, conducted between August 2013 and March 2014 in 118 Brazilian ICUs. Phase 2 was a cluster randomized trial conducted between April and November 2014 with the same ICUs. The first 60 admissions of longer than 48 hours per ICU were enrolled in each phase. INTERVENTIONS: Intensive care units were randomized to a quality improvement intervention, including a daily checklist and goal setting during multidisciplinary rounds with follow-up clinician promptingfor 11 care processes, or to routine care. MAIN OUTCOMES AND MEASURES: In-hospital mortality truncated at 60 days (primary outcome) was analyzed using a random-effects logistic regression model, adjusted for patients' severity and the ICU's baseline standardized mortality ratio. Exploratory secondary outcomes included adherence to care processes, safety climate, and clinical events. RESULTS: A total of 6877 patients (mean age, 59.7 years; 3218 [46.8%] women) were enrolled in the baseline (observational) phase and 6761 (mean age, 59.6 years; 3098 [45.8%] women) in the randomized phase, with 3327 patients enrolled in ICUs (n = 59) assigned to the intervention group and 3434 patients in ICUs (n = 59) assigned to routine care. There was no significant difference in in-hospital mortality between the intervention group and the usual care group, with 1096 deaths (32.9%) and 1196 deaths (34.8%), respectively (odds ratio, 1.02; 95% CI, 0.82-1.26; P =.88). Among 20 prespecified secondary outcomes not adjusted for multiple comparisons, 6 were significantly improved in the intervention group (use of low tidal volumes, avoidance of heavy sedation, use of central venous catheters, use of urinary catheters, perception of team work, and perception of patient safety climate), whereas there were no significant differences between the intervention group and the control group for 14 outcomes (ICU mortality, central line-associated bloodstream infection, ventilator-associated pneumonia, urinary tract infection, mean ventilator-free days, mean ICU length of stay, mean hospital length of stay, bed elevation to ≥30°, venous thromboembolism prophylaxis, diet administration, job satisfaction, stress reduction, perception of management, and perception of working conditions). CONCLUSIONS AND RELEVANCE: Among critically ill patients treated in ICUs in Brazil, implementation of a multifaceted quality improvement intervention with daily checklists, goal setting, and clinician prompting did not reduce in-hospital mortality. Copyright 2016 American Medical Association. All rights reserved. DA - 2016/// PY - 2016 VL - 315 IS - 14 SP - 1480 EP - 1490 UR - https://www.scopus.com/inward/record.uri?eid=2-s2.0-84963820897&doi=10.1001%2fjama.2016.3463&partnerID=40&md5=fb262cdcaed4a744db9e777f60ddb472 AN - rayyan-105238374 N1 -Cited By :73 Export Date: 28 September 2020 RAYYAN-INCLUSION: {"Victor Hugo"=>"Included"}
KW - Critical Illness ER - TY - JOUR TI - Improving the postoperative handover process in the intensive care unit of a tertiary teaching hospital AU - Yang, J.-G. AU - Zhang, J. T2 - Journal of Clinical Nursing AB - Aims and objectives: The aim of this study was to improve the postoperative handover process and immediate postoperative patient outcomes. The objective was to implement a postoperative handover protocol in the neurosurgical intensive care unit of a tertiary teaching hospital. Background: Postoperative handover is a multidisciplinary collaborative medical activity that involves information transfer, sequenced tasks and high-quality teamwork. Evidence suggests that a lack of a standardised postoperative handover protocol adversely influences care quality and potentially compromises patient safety. As there is a lack of such protocols in China, there is an identified need for improvement. Design: This was a pretest/post-test study with follow-up after three months. Methods: A postoperative handover protocol that included a postoperative handover checklist, a standardised handover pathway and core team member involvement was developed based on research evidence and expert opinions and was then implemented and evaluated. Results: Following the implementation of this protocol, improved teamwork was achieved, surgeons were more frequently present at bedside handovers, the rate of transferring key messages increased, the rate of ventilator weaning within the first six hours of neurosurgical intensive care unit admission increased, and the ventilation duration per patient decreased without any clinical incident occurring in the first 24 hours after neurosurgical intensive care unit admission. Conclusions: Following the implementation of a tailored standardised handover protocol, communication, teamwork and short-term patient outcomes were improved. Relevance to clinical practice: This clinically based research highlights the need for policy makers and administrators to create unit-specific protocols for improving postoperative handovers. © 2016 John Wiley & Sons Ltd. DA - 2016/// PY - 2016 VL - 25 IS - 7 SP - 1062 EP - 1072 UR - https://www.scopus.com/inward/record.uri?eid=2-s2.0-84961231154&doi=10.1111%2fjocn.13115&partnerID=40&md5=18b5c256b47566d142a1208d32da6017 AN - rayyan-105238376 N1 -Cited By :11 Export Date: 28 September 2020 RAYYAN-INCLUSION: {"Victor Hugo"=>"Included"}
KW - Intensive Care Units ER - TY - JOUR TI - New ways to evaluate patient safety relevant topics: Patient-safety feedback AU - Sendlhofer, G. AU - Leitgeb, K. AU - Kober, B. AU - Brunner, G. AU - Tax, C. AU - Kamolz, L.-P. T2 - Zeitschrift fur Evidenz, Fortbildung und Qualitat im Gesundheitswesen AB - Background Patient safety has become a hot topic, and there are numerous initiatives ongoing to improve patient-relevant processes. But how can both the effectiveness and sustainability of these initiatives be evaluated? The aim of the present paper was to describe the development of an instrument to assess patient safety aspects which can be used for normal hospital ward and intensive care unit rounds or in the operating room. Methodology All relevant patient safety guidelines and checklists of the University Hospital Graz were screened. Subsequently, questions were extracted from these documents which can be used in a checklist for “real-time” ward rounds by local observers. Results Based on the document screening two sets of criteria were prepared, one for operating rooms and one for normal hospital wards and intensive care units. Using a survey tool two checklists were then generated on the basis of these criteria, which can be used for the so-called “patient-safety feedback” from the observers. Conclusion Whether guidelines or checklists, which should theoretically improve patient safety, are properly understood and applied as intended by healthcare professionals can only be evaluated by using methods like monitoring the respective processes. The checklists for conducting the so-called “patient-safety feedback” seem to be an effective instrument to assess patient safety-relevant processes in “real-time”. © 2016 DA - 2016/// PY - 2016 VL - 114 SP - 13 EP - 27 UR - https://www.scopus.com/inward/record.uri?eid=2-s2.0-84973542318&doi=10.1016%2fj.zefq.2016.05.008&partnerID=40&md5=a96d49020aec4ac8879443fb6a780a66 AN - rayyan-105238378 N1 -Cited By :1 Export Date: 28 September 2020 RAYYAN-INCLUSION: {"Victor Hugo"=>"Included"}
KW - Feedback ER - TY - JOUR TI - Testing the implementation of an electronic process-of-care checklist for use during morning medical rounds in a tertiary intensive care unit: a prospective before–after study AU - Conroy, K.M. AU - Elliott, D. AU - Burrell, A.R. T2 - Annals of Intensive Care AB - Background: To improve the delivery of important care processes in the ICU, morning ward round checklists have been implemented in a number of intensive care units (ICUs) internationally. Good quality evidence supporting their use as clinical support tools is lacking. With increased use of technology in clinical settings, integration of such tools into current work practices can be a challenge and requires evaluation. Having completed preliminary work revealing variations in practice and evidence supporting the construct validity of a process-of-care checklist, the need to develop, test and further validate an e(lectronic)-checklist in an ICU was identified. Methods: A prospective, before–after study was conducted in a 19-bed general ICU within a tertiary hospital. Data collection occurred during baseline and intervention periods for 6 weeks each, with education and training conducted over a 4-week period prior to intervention. The e-checklist was used at baseline by ICU research nurses conducting post-ward round audits. During intervention, senior medical staff completed the e-checklist after patient assessments during the morning ward rounds, and research staff conducted post-ward round audits for validity testing (via concordance measurement). To examine changes in compliance over time, checklist-level data were analysed using generalised estimating equations that factored in confounding variables, and statistical process control charts were used to evaluate unit-level data. Established measures of concordance were used to evaluate e-checklist validity. Results: Compliance with each care component improved significantly over time; the largest improvement was for pain management (42% increase; adjusted odds ratio = 23, p < 0.001), followed by glucose management (22% increase, p < 0.001) and head-of-bed elevation (19% increase, p < 0.001), both with odds ratios greater than 10. Most detected omissions were corrected by the following day. Control charts illustrated reduced variability in care compliance over time. There was good concordance between physician and auditor e-checklist responses; seven out of nine cares had kappa values above 0.8. Conclusion: Improvements in the delivery of essential daily care processes were evidenced after the introduction of an e-checklist to the morning ward rounds in an ICU. High levels of agreement between physician and independent audit responses lend support to the validity of the e-checklist. © 2015, Conroy et al. DA - 2015/// PY - 2015 VL - 5 IS - 1 UR - https://www.scopus.com/inward/record.uri?eid=2-s2.0-84938567607&doi=10.1186%2fs13613-015-0060-1&partnerID=40&md5=2935da1d093091ec30879f5b61a80091 AN - rayyan-105238385 N1 -Cited By :8 Export Date: 28 September 2020 RAYYAN-INCLUSION: {"Victor Hugo"=>"Included"}
KW - Intensive Care Units ER - TY - JOUR TI - Checklist for the intrahospital transport of patients admitted to the intensive care unit AU - Silva, R. AU - Amante, L.N. T2 - Texto e Contexto Enfermagem AB - Checklists represent a simple tool incorporating barriers for protecting patient safety. The objective was to develop a script for patient evaluation for the intrahospital transport of patients admitted to the Intensive Care Unit of a hospital in the Triângulo Mineiro region, based on two strategies. The first: a descriptive, prospective and quantitative study; the second: integrative research, undertaken in four databases. It was ascertained that the incidents are related to breakdowns and problems related to poor functioning in equipment and devices, with adverse events being frequent involving variation in blood pressure, agitation, drops in peripheral arterial saturation and tachycardia. Emphasis is also placed on the need to verify the effectiveness of the present script for patient evaluation for intrahospital transport in relation to patient safety, and its level of practicality through its use in the varying hospital spaces, such that the same may become a checklist. © 2015, Universidade Federal de Santa Catarina. All rights reserved. DA - 2015/// PY - 2015 VL - 24 IS - 2 SP - 539 EP - 547 UR - https://www.scopus.com/inward/record.uri?eid=2-s2.0-84938502877&doi=10.1590%2f0104-07072015001772014&partnerID=40&md5=52ba626f3be192ffdd0751e5bc582d79 AN - rayyan-105238401 N1 -Cited By :3 Export Date: 28 September 2020 RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Intensive Care Units KW - Transportation of Patients ER - TY - JOUR TI - Care practices for patient safety in an intensive care unit AU - Barbosa, T.P. AU - De Oliveira, G.A.A. AU - Lopes, M.N.D.A. AU - Poletti, N.A.A. AU - Beccaria, L.M. T2 - ACTA Paulista de Enfermagem AB - Objective: To investigate good nursing care practices for patient safety in an intensive care unit. Methods: Descriptive study using a checklist with 19 items on hygiene/comfort, patient identification/falls and hospital infection. Four hundred fifty records were analyzed through G test of independence with Williams correction. Results: Altogether, good care practices are delivered with an index above 90%, exception for position changing, limb restraints kept clean, and ventilator circuit. Conclusion: Good nursing care practices for patient safety were performed differently based on work shifts. DA - 2014/// PY - 2014 VL - 27 IS - 3 SP - 243 EP - 248 UR - https://www.scopus.com/inward/record.uri?eid=2-s2.0-84907262669&doi=10.1590%2f1982-0194201400041&partnerID=40&md5=f4d0661faede20bb1427ca679b3d17f0 AN - rayyan-105238422 N1 -Cited By :6 Export Date: 28 September 2020 RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
ER - TY - JOUR TI - Long-term persistence of quality improvements for an intensive care unit communication initiative using the VALUE strategy AU - Wysham, N.G. AU - Mularski, R.A. AU - Schmidt, D.M. AU - Nord, S.C. AU - Louis, D.L. AU - Shuster, E. AU - Curtis, J.R. AU - Mosen, D.M. T2 - Journal of Critical Care AB - Purpose: Communication in the intensive care unit (ICU) is an important component of quality ICU care. In this report, we evaluate the long-term effects of a quality improvement (QI) initiative, based on the VALUE communication strategy, designed to improve communication with family members of critically ill patients. Materials and Methods: We implemented a multifaceted intervention to improve communication in the ICU and measured processes of care. Quality improvement components included posted VALUE placards, templated progress note inclusive of communication documentation, and a daily rounding checklist prompt. We evaluated care for all patients cared for by the intensivists during three separate 3 week periods, pre, post, and 3 years following the initial intervention. Results: Care delivery was assessed in 38 patients and their families in the pre-intervention sample, 27 in the post-intervention period, and 41 in follow-up. Process measures of communication showed improvement across the evaluation periods, for example, daily updates increased from pre 62% to post 76% to current 84% of opportunities. Conclusions: Our evaluation of this quality improvement project suggests persistence and continued improvements in the delivery of measured aspects of ICU family communication. Maintenance with point-of-care-tools may account for some of the persistence and continued improvements. © 2014 Elsevier Inc. DA - 2014/// PY - 2014 VL - 29 IS - 3 SP - 450 EP - 454 UR - https://www.scopus.com/inward/record.uri?eid=2-s2.0-84899928955&doi=10.1016%2fj.jcrc.2013.12.006&partnerID=40&md5=86b87f39a3b06fc9ce3ab0ab64123cf5 AN - rayyan-105238426 N1 -Cited By :17 Export Date: 28 September 2020 RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Intensive Care Units ER - TY - BOOK TI - New cost-effective treatment strategies for acute emergency situations AU - Chandra, S. AU - Chong, D.H. T2 - Annual Review of Medicine AB - In an era of ever-increasing healthcare costs, new treatments must not only improve outcomes and quality of care but also be cost-effective. This is most challenging for emergency and critical care. Bigger and better has been the mantra of Western medical care for decades, leading to costlier but not necessarily better care. Recent advances focused on new implementation processes for evidence-based best practices such as checklists and bundles have transformed medical care. We outline recent advances in medical practice that have positively affected both the quality of care and its cost-effectiveness. Future medical care must be smarter and more effective if we are to meet the increasing demands of an aging patient population in the context of ever more limited resources. © 2014 by Annual Reviews. All rights reserved. DA - 2014/// PY - 2014 VL - 65 SP - 459-469 UR - https://www.scopus.com/inward/record.uri?eid=2-s2.0-84901489164&doi=10.1146%2fannurev-med-060112-095857&partnerID=40&md5=c826dfa970c73e0fe7c5fb2dfdb3e3ec AN - rayyan-105238429 N1 -Export Date: 28 September 2020 RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Emergencies KW - Cost-Benefit Analysis ER - TY - JOUR TI - Cardiac surgical ICU care: Eliminating "preventable" complications AU - Shake, J.G. AU - Pronovost, P.J. AU - Whitman, G.J.R. T2 - Journal of Cardiac Surgery AB - The goal of this article is to provide an outline of the latest advances in critical care that pertain to the open heart surgery patient, pinpointing initiatives that would enable physicians and institutions to successfully implement guidelines, protocols, checklists, and initiatives that have been shown to improve patient safety. doi: 10.1111/jocs.12124 (J Card Surg 2013;28:406-413) © 2013 Wiley Periodicals, Inc. DA - 2013/// PY - 2013 VL - 28 IS - 4 SP - 406 EP - 413 UR - https://www.scopus.com/inward/record.uri?eid=2-s2.0-84880771461&doi=10.1111%2fjocs.12124&partnerID=40&md5=4ecef4e21cda5a8e5e01c15c8bc6cd49 AN - rayyan-105238451 N1 -Cited By :10 Export Date: 28 September 2020 RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
ER - TY - JOUR TI - Development and reliability of the explicit professional oral communication observation tool to quantify the use of non-technical skills in healthcare AU - Kemper, P.F. AU - Van Noord, I. AU - De Bruijne, M. AU - Knol, D.L. AU - Wagner, C. AU - Van Dyck, C. T2 - BMJ Quality and Safety AB - Background A lack of non-technical skills is increasingly recognised as an important underlying cause of adverse events in healthcare. The nature and number of things professionals communicate to each other can be perceived as a product of their use of non-technical skills. This paper describes the development and reliability of an instrument to measure and quantify the use of non-technical skills by direct observations of explicit professional oral communication (EPOC) in the clinical situation. Methods In an iterative process we translated, tested and refined an existing checklist from the aviation industry, called self, human interaction, aircraft, procedures and environment, in the context of healthcare, notably emergency departments (ED) and intensive care units (ICU). The EPOC comprises six dimensions: assertiveness, working with others; task-oriented leadership; people-oriented leadership; situational awareness; planning and anticipation. Each dimension is specified into several concrete items reflecting verbal behaviours. The EPOC was evaluated in four ED and six ICU. Results In the ED and ICU, respectively, 378 and 1144 individual and 51 and 68 contemporaneous observations of individual staff members were conducted. All EPOC dimensions occur frequently, apart from assertiveness, which was hardly observed. Intraclass correlations for the overall EPOC score ranged between 0.85 and 0.91 and for underlying EPOC dimensions between 0.53 and 0.95. Conclusions The EPOC is a new instrument for evaluating the use of non-technical skills in healthcare, which is reliable in two highly different settings. By quantifying professional behaviour the instrument facilitates measurement of behavioural change over time. The results suggest that EPOC can also be translated to other settings. DA - 2013/// PY - 2013 VL - 22 IS - 7 SP - 586 EP - 595 UR - https://www.scopus.com/inward/record.uri?eid=2-s2.0-84879413393&doi=10.1136%2fbmjqs-2012-001451&partnerID=40&md5=cb0a983119cb7c1059d0a329c124b675 AN - rayyan-105238453 N1 -Cited By :12 Export Date: 28 September 2020 RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
ER - TY - JOUR TI - Nursing protocol violations: Detect, correct and communicate AU - Te Beest, H. AU - Van der Starre, C. AU - Tibboel, D. AU - Van Dijk, M. T2 - Nursing in Critical Care AB - Aims and objectives: The Critical Nursing Situation Index (CNSI) is a checklist to detect nursing protocol violations. The objectives of this study were to determine incidences and severities of nursing protocol violations and to check whether corrective actions were taken. Design: Prospective observational audit. Methods: This study was performed in the Intensive Care Unit of the Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands. The CNSI was applied in the period February 2009 to February 2010 by 14 purpose-trained nurses whose interrater reliability had proved sufficient. The checklist addressed nine domains of nursing care: Basic care, Circulation, Respiration, Digestive tract, Infection, Invasive catheters, Medication, ECMO and Central nervous system. The trained nurses also recorded whether violations were discussed with the bedside nurse, whether they could be corrected; and whether they were justifiable. Protocol violations are justifiable when protocol adherence carries greater risk of harm to the patient. Results: Protocol violations were identified for 987 of 8107 items (12·2%) checked in 238 observations in 126 patients. The percentage of protocol violations varied from 5% in the Medication domain to 26% in the Digestive tract domain. More than fifty percent (53·4%) of all protocol violations were corrected in the same shift; 22·3% of all protocol violations proved justifiable, however, these were rarely documented (6·4% of cases). Nurses' classification of the severity of the protocol violations was not reliable because linearly weighted kappa varied from 0 to 0·33. Conclusions: The CNSI is a useful tool to monitor and correct nursing protocol violations. Relevance to clinical practice: Timely identification and correction of protocol violations will reduce possible adverse events resulting from these violations. Furthermore, this study made us aware that protocol violations may be justifiable in clinical practice provided they are well documented. © 2012 British Association of Critical Care Nurses. DA - 2013/// PY - 2013 VL - 18 IS - 2 SP - 79 EP - 85 UR - https://www.scopus.com/inward/record.uri?eid=2-s2.0-84874070278&doi=10.1111%2fj.1478-5153.2012.00533.x&partnerID=40&md5=daeb42e2d6f0ff529461d700f8a81258 AN - rayyan-105238457 N1 -Cited By :3 Export Date: 28 September 2020 RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Nursing Assessment ER - TY - JOUR TI - [The effect of an intervention on rates of central vascular catheter-related bloodstream infection in intensive care units at the Hadassah Medical Center]. AU - Gross, I. AU - Block, C. AU - Benenson, S. AU - Cohen, M.J. AU - Brezis, M. T2 - Harefuah AB - Catheter-related bloodstream infection (CR-BSI) is a significant source for morbidity and mortality in addition to increased hospital costs. Patients in intensive care units (ICUs) have a greater risk for CR-BSI. Continuous monitoring and control of intravascular central catheters insertion (CCI) by using checklists have a key role in reducing the rate of infections and improving patient health care quality and safety. To determine the rate of CR-BSI, and to evaluate the adherence of ICU teams to infection control guidelines during CCI prior to and following an intervention program in ICU patients. The present study was conducted in six ICUs at the Hadassah Medical Center, during a period of 15 months. The rate of CR-BSI was determined in 320 patients with central catheters during the first period of the study. Assessment of adherence to infection control guidelines during CCI was carried out by observations. Educational intervention consisted of the introduction of physician guidelines for CCI, implementing a checklist to ensure adherence to the guidelines and lectures for the teams, beginning in the second period of the study. During the third period of the study, the rate of CR-BSI was determined in 336 patients with central catheters in the same ICUs, by the same research methods. Following the intervention, a significant reduction in the rate of CR-BSI was observed in the study population from 9.66 to 3.63 infections per 1000 catheter days, with 62.4% risk reduction for CR-BSI, (P < 0.001). Improvements were also recorded in the CCI process and the rate of compliance of the ICUs team with infection control guidelines. The implementation of a simple and inexpensive intervention reduced the rate of CR-BSI, leading to improved process of insertion of these catheters. The continuous monitoring of the rate of CR-BSI and using checklists in every CCI process may reduce the morbidity, mortality, hospital stay, and lower hospital costs associated with centrally placed vascular catheters. DA - 2013/// PY - 2013 VL - 152 IS - 1 SP - 16 EP - 20, 60 UR - https://www.scopus.com/inward/record.uri?eid=2-s2.0-84875903686&partnerID=40&md5=345f4d48b332476ebb35c5d9d9f91e22 AN - rayyan-105238461 N1 -Cited By :2 Export Date: 28 September 2020 RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Intensive Care Units ER - TY - JOUR TI - Development of communication tool for patient safety (" Briefing" ). Experience in a trauma and emergency intensive care unit AU - Chico Fernández, M. AU - García Fuentes, C. AU - Alonso Fernández, M.A. AU - Toral Vázquez, D. AU - Bermejo Aznárez, S. AU - Sánchez-Izquierdo Riera, J.A. AU - Alted López, E. T2 - Medicina Intensiva AB - Objective: To validate a safety tool used in high-risk sectors (safety briefing) in intensive care medicine. Design: A prospective, observational and analytical study was carried out. Setting: Trauma and emergency intensive care unit in a tertiary hospital. Patients: Patients with severe trauma (Injury Severity Score ISS≥16). Intervention: Documentation of incidents related to patient safety (PS). Variables: Patients characteristics, state of the Unit, patient safety incidents, aspects of the tool (SP) and safety culture impact. Results: We included 441 patients (75.15% males, mean age 39.9 ± 17.5 years), with blunt trauma in 89% and a 10.5% mortality rate. The tool was applied in 586 out of 798 possible shifts (73.4%), and documented 942 events (2.20 incidents per patient). The incidents were more frequently associated with medication (20.7%), devices (placement 4.03%, and maintenance 17.8%) and airway and mechanical ventilation (MV) (17.09%). A correlation was established between the occurrence of incidents and the characteristics of the patient (higher Injury Severity Score, presence of MV, and continuous renal replacement therapies) and the status of the Unit (more than 6 patients per shift out of 8 possible, and holiday period). The tool significantly influenced different aspects of the safety culture of the unit (communication frequency, number of events, punitive loss and active work in PS). Conclusions: Safety briefing is a tool for the documentation of incidents that is simple and easy to use, and is useful for implementing improvements and in influencing safety culture. © 2011 Elsevier España, S.L. y SEMICYUC. DA - 2012/// PY - 2012 VL - 36 IS - 7 SP - 481 EP - 487 UR - https://www.scopus.com/inward/record.uri?eid=2-s2.0-84864131379&doi=10.1016%2fj.medin.2011.11.023&partnerID=40&md5=c5bb9aa4ddcc8f0294a68d42cce58b6d AN - rayyan-105238465 N1 -Cited By :4 Export Date: 28 September 2020 RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
ER - TY - JOUR TI - Handling continuous renal replacement therapy-related adverse effects in intensive care unit patients: The dialytrauma concept AU - Maynar Moliner, J. AU - Honore, P.M. AU - Sánchez-Izquierdo Riera, J.A. AU - Herrera Gutiérrez, M. AU - Spapen, H.D. T2 - Blood Purification AB - Continuous renal replacement therapy (CRRT) is increasingly used for the management of critically ill patients. As a consequence, the incidence of complications that accompany CRRT is also rising. However, a standardized approach for preventing or minimizing these adverse events is lacking. Dialytrauma is a newly proposed concept that encompasses all harmful adverse events related to CRRT while providing a framework for prevention or, at the least, early recognition of these events in order to attenuate the consequences. A mainstay of this approach is the utilization of a dedicated checklist for improving CRRT quality and patient safety. In this context, we discuss the most important adverse effects of CRRT and review current strategies to minimize them. Copyright © 2012 S. Karger AG, Basel. DA - 2012/// PY - 2012 VL - 34 IS - 2 SP - 177 EP - 185 UR - https://www.scopus.com/inward/record.uri?eid=2-s2.0-84867946326&doi=10.1159%2f000342064&partnerID=40&md5=2af3154ff1ee5231a2dd515dd8cf6ecf AN - rayyan-105238466 N1 -Cited By :35 Export Date: 28 September 2020 RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Intensive Care Units KW - Renal Replacement Therapy ER - TY - JOUR TI - Can we make postoperative patient handovers safer? a systematic review of the literature AU - Segall, N. AU - Bonifacio, A.S. AU - Schroeder, R.A. AU - Barbeito, A. AU - Rogers, D. AU - Thornlow, D.K. AU - Emery, J. AU - Kellum, S. AU - Wright, M.C. AU - Mark, J.B. T2 - Anesthesia and Analgesia AB - Postoperative patient handovers are fraught with technical and communication errors and may negatively impact patient safety. We systematically reviewed the literature on handover of care operating room to postanesthesia or intensive care units and summarized process and communication recommendations based on these findings. From >500 papers, we identified 31 dealing with postoperative handovers. Twenty-four included recommendations for structuring the handover process or information transfer. Several recommendations were broadly supported, including (1) standardize processes (e.g., through the use of checklists and protocols); (2) complete urgent clinical tasks before the information transfer; (3) allow only patient-specific discussions during verbal handovers; (4) require that all relevant team members be present; and (5) provide training in team skills and communication. Only 4 of the studies developed an intervention and formally assessed its impact on different process measures. All 4 interventions improved metrics of effectiveness, efficiency, and perceived teamwork. Most of the papers were cross-sectional studies that identified barriers to safe, effective postoperative handovers including the incomplete transfer of information and other communication issues, inconsistent or incomplete teams, absent or inefficient execution of clinical tasks, and poor standardization. An association between poor-quality handovers and adverse events was also demonstrated. More innovative research is needed to define optimal patient handovers and to determine the effect of handover quality on patient outcomes. Copyright © 2012 International Anesthesia Research Society. DA - 2012/// PY - 2012 VL - 115 IS - 1 SP - 102 EP - 115 UR - https://www.scopus.com/inward/record.uri?eid=2-s2.0-84863008652&doi=10.1213%2fANE.0b013e318253af4b&partnerID=40&md5=08d91fb8a51fbe15cf0934c8bffa35d1 AN - rayyan-105238469 N1 -Cited By :130 Export Date: 28 September 2020 RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
ER - TY - JOUR TI - Surveillance: A strategy for improving patient safety in acute and critical care units AU - Henneman, E.A. AU - Gawlinski, A. AU - Giuliano, K.K. T2 - Critical Care Nurse AB - Surveillance is a nursing intervention that has been identified as an important strategy in preventing and identifying medical errors and adverse events. The definition of surveillance proposed by the Nursing Intervention Classification is the purposeful and ongoing acquisition, interpretation, and synthesis of patient data for clinical decision making. The term surveillance is often used interchangeably with the term monitoring, yet surveillance differs significantly from monitoring both in purpose and scope. Monitoring is a key activity in the surveillance process, but monitoring alone is insufficient for conducting effective surveillance. Much of the attention in the bedside patient safety movement has been focused on efforts to implement processes that ultimately improve the surveillance process. These include checklists, interdisciplinary rounds, clinical information systems, and clinical decision support systems. To identify optimal surveillance patterns and to develop and test technologies that assist critical care nurses in performing effective surveillance, more research is needed, particularly with innovative approaches to describe and evaluate the best surveillance practices of bedside nurses. © 2012 American Association of Critical-Care Nurses. DA - 2012/// PY - 2012 VL - 32 IS - 2 SP - e9 EP - e18 UR - https://www.scopus.com/inward/record.uri?eid=2-s2.0-84861159920&doi=10.4037%2fccn2012166&partnerID=40&md5=1db99d0803510a3444e5e0c1aca281de AN - rayyan-105238472 N1 -Cited By :46 Export Date: 28 September 2020 RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Critical Care ER - TY - JOUR TI - Pilot implementation of a perioperative protocol to guide operating room-to-intensive care unit patient handoffs AU - Petrovic, M.A. AU - Aboumatar, H. AU - Baumgartner, W.A. AU - Ulatowski, J.A. AU - Moyer, J. AU - Chang, T.Y. AU - Camp, M.S. AU - Kowalski, J. AU - Senger, C.M. AU - Martinez, E.A. T2 - Journal of Cardiothoracic and Vascular Anesthesia AB - Objectives: Perioperative handoffs are a particularly high-risk period given patients' postprocedural physiology, their physical transport through the hospital, and the triad transfer of personnel, information, and technology. The authors piloted a new perioperative handoff process to guide patient transfers from the cardiac operating room (OR) to the cardiac surgical intensive care unit (CSICU). The aim of the study was to evaluate the impact of a standardized handoff process on patient care and provider satisfaction. Design: A prospective, unblinded intervention study. Setting: A CSICU in a teaching hospital. Participants: Two hundred thirty-eight health care practitioners during the transfer of care of 60 patients. Interventions: The implementation of a standardized handoff protocol and checklist. Measurements and Main Results: After the protocol's implementation, the presence of all handoff core team members at the bedside increased from 0% at baseline to 68% after intervention. The percentage of missed information in the surgery report decreased from 26% to 16% (p = 0.03), but the percentage of missed information in the anesthesia report showed no significant change (19% to 17%, p > 0.05). Handoff satisfaction scores among intensive care unit (ICU) nurses increased from 61% to 81%. On average, the duration of handoff increased by 1 minute. Conclusions: A standardized handoff protocol that guides the transfer of care from the OR team to the CSICU team can reduce the risk of missed information and improve satisfaction among perioperative providers. © 2012 Elsevier Inc. All rights reserved. DA - 2012/// PY - 2012 VL - 26 IS - 1 SP - 11 EP - 16 UR - https://www.scopus.com/inward/record.uri?eid=2-s2.0-84855328305&doi=10.1053%2fj.jvca.2011.07.009&partnerID=40&md5=4dffb703b8d0c3288a1ba9e70cb70910 AN - rayyan-105238475 N1 -Cited By :77 Export Date: 28 September 2020 RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Intensive Care Units ER - TY - JOUR TI - Protocol adherence in the intensive care unit AU - Drews, F.A. AU - Wallace, J. AU - Benuzillo, J. AU - Markewitz, B. AU - Samore, M. T2 - Human Factors and Ergonomics In Manufacturing AB - Checklists and protocols have been successfully introduced into aviation with improved safety as a result of this effort. In recent years there have been attempts to introduce protocols and checklists to health care with the goal of improving patient safety. The present study investigates adherence to protocols in the intensive care unit (ICU) in a number of nursing tasks. The results of this work indicate that adherence to protocols varies dramatically between tasks. This finding suggests that adherence is often a function of task and equipment design. In addition, the context in which protocols are being used also potentially determines their success. Overall, the results indicate that protocols can be introduced in health care, but additional considerations have to be taken into account to ensure their successful application. © 2011 Wiley Periodicals, Inc. DA - 2012/// PY - 2012 VL - 22 IS - 1 SP - 21 EP - 31 UR - https://www.scopus.com/inward/record.uri?eid=2-s2.0-84355162956&doi=10.1002%2fhfm.20280&partnerID=40&md5=66bb85bca584ae63f31e4c5cfc5e92b1 AN - rayyan-105238476 N1 -Cited By :9 Export Date: 28 September 2020 RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Intensive Care Units ER - TY - JOUR TI - Ensuring patient safety in care transitions: an empirical evaluation of a Handoff Intervention Tool. AU - Abraham, J. AU - Kannampallil, T. AU - Patel, B. AU - Almoosa, K. AU - Patel, V.L. T2 - AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium AB - Successful handoffs ensure smooth, efficient and safe patient care transitions. Tools and systems designed for standardization of clinician handoffs often focuses on ensuring the communication activity during transitions, with limited support for preparatory activities such as information seeking and organization. We designed and evaluated a Handoff Intervention Tool (HAND-IT) based on a checklist-inspired, body system format allowing structured information organization, and a problem-case narrative format allowing temporal description of patient care events. Based on a pre-post prospective study using a multi-method analysis we evaluated the effectiveness of HAND-IT as a documentation tool. We found that the use of HAND-IT led to fewer transition breakdowns, greater tool resilience, and likely led to better learning outcomes for less-experienced clinicians when compared to the current tool. We discuss the implications of our results for improving patient safety with a continuity of care-based approach. DA - 2012/// PY - 2012 VL - 2012 SP - 17 EP - 26 UR - https://www.scopus.com/inward/record.uri?eid=2-s2.0-84880726941&partnerID=40&md5=fdb9594030a1f5424e87652b8a02df41 AN - rayyan-105238478 N1 -Cited By :20 Export Date: 28 September 2020 RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
ER - TY - JOUR TI - Quality improvement projects targeting health care-associated infections: Comparing virtual collaborative and toolkit approaches AU - Speroff, T. AU - Ely, E.W. AU - Greevy, R. AU - Weinger, M.B. AU - Talbot, T.R. AU - Wall, R.J. AU - Deshpande, J.K. AU - France, D.J. AU - Nwosu, S. AU - Burgess, H. AU - Englebright, J. AU - Williams, M.V. AU - Dittus, R.S. T2 - Journal of Hospital Medicine AB - Background: Collaborative and toolkit approaches have gained traction for improving quality in health care. Objective: To determine if a quality improvement virtual collaborative intervention would perform better than a toolkit-only approach at preventing central line-associated bloodstream infections (CLABSIs) and ventilator-associated pneumonias (VAPs). Design and Setting: Cluster randomized trial with the Intensive Care Units (ICUs) of 60 hospitals assigned to the Toolkit (n=29) or Virtual Collaborative (n=31) group from January 2006 through September 2007. Measurement: CLABSI and VAP rates. Follow-up survey on improvement interventions, toolkit utilization, and strategies for implementing improvement. Results: A total of 83% of the Collaborative ICUs implemented all CLABSI interventions compared to 64% of those in the Toolkit group (P = 0.13), implemented daily catheter reviews more often (P = 0.04), and began this intervention sooner (P < 0.01). Eighty-six percent of the Collaborative group implemented the VAP bundle compared to 64% of the Toolkit group (P = 0.06). The CLABSI rate was 2.42 infections per 1000 catheter days at baseline and 2.73 at 18 months (P = 0.59). The VAP rate was 3.97 per 1000 ventilator days at baseline and 4.61 at 18 months (P = 0.50). Neither group improved outcomes over time; there was no differential performance between the 2 groups for either CLABSI rates (P = 0.71) or VAP rates (P = 0.80). Conclusion: The intensive collaborative approach outpaced the simpler toolkit approach in changing processes of care, but neither approach improved outcomes. Incorporating quality improvement methods, such as ICU checklists, into routine care processes is complex, highly context-dependent, and may take longer than 18 months to achieve. © 2011 Society of Hospital Medicine. DA - 2011/// PY - 2011 VL - 6 IS - 5 SP - 271 EP - 278 UR - https://www.scopus.com/inward/record.uri?eid=2-s2.0-79958699593&doi=10.1002%2fjhm.873&partnerID=40&md5=90d2e0cf98a53d450bc6acd5a1a4754e AN - rayyan-105238486 N1 -Cited By :20 Export Date: 28 September 2020 RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
ER - TY - JOUR TI - Does standardization of critical care work? AU - Hasibeder, W.R. T2 - Current Opinion in Critical Care AB - Purpose of review This article discusses how standardization of intensive care work may decrease morbidity and mortality in the intensive care unit (ICU) by reducing practice variation and improving the overall quality of care. In this context, standardization should not only apply to the specific medical management of certain high-volume ICU diagnoses but should also be established for daily ICU procedures and information transmission during ward rounds and at the interface of interdisciplinary work. Recent findings Standardized procedures for placement of central venous catheters, implementation of strict hand hygiene and treatment of specific high volume ICU diagnoses using protocol-guided treatment algorithms or treatment bundles have convincingly demonstrated to decrease patient morbidity and mortality and healthcare expenditures. Standardization processes to improve patient-centered communication in the ICU are still in their early stages. Summary Standardization of most aspects of intensive care medicine has an enormous potential to improve patient care and outcome, reduce ICU/hospital length of stay as well as healthcare expenditures. Despite promising results from large studies standards known to improve patient outcome have not yet been widely implemented. Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. DA - 2010/// PY - 2010 VL - 16 IS - 5 SP - 493 EP - 498 UR - https://www.scopus.com/inward/record.uri?eid=2-s2.0-78449310718&doi=10.1097%2fMCC.0b013e32833cb84a&partnerID=40&md5=026c3a9cb6267cb291609501911c5a57 AN - rayyan-105238494 N1 -Cited By :25 Export Date: 28 September 2020 RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Critical Care ER - TY - JOUR TI - Recommendations for the intra-hospital transport of critically ill patients AU - Fanara, B. AU - Manzon, C. AU - Barbot, O. AU - Desmettre, T. AU - Capellier, G. T2 - Critical Care AB - Introduction: This study was conducted to provide Intensive Care Units and Emergency Departments with a set of practical procedures (check-lists) for managing critically-ill adult patients in order to avoid complications during intra-hospital transport (IHT).Methods: Digital research was carried out via the MEDLINE, EMBASE, CINAHL and HEALTHSTAR databases using the following key words: transferring, transport, intrahospital or intra-hospital, and critically ill patient. The reference bibliographies of each of the selected articles between 1998 and 2009 were also studied.Results: This review focuses on the analysis and overcoming of IHT-related risks, the associated adverse events, and their nature and incidence. The suggested preventive measures are also reviewed. A check-list for quick execution of IHT is then put forward and justified.Conclusions: Despite improvements in IHT practices, significant risks are still involved. Basic training, good clinical sense and a risk-benefit analysis are currently the only deciding factors. A critically ill patient, prepared and accompanied by an inexperienced team, is a risky combination. The development of adapted equipment and the widespread use of check-lists and proper training programmes would increase the safety of IHT and reduce the risks in the long-term. Further investigation is required in order to evaluate the protective role of such preventive measures. © 2010 Fanara et al.; licensee BioMed Central Ltd. DA - 2010/// PY - 2010 VL - 14 IS - 3 UR - https://www.scopus.com/inward/record.uri?eid=2-s2.0-77952086521&doi=10.1186%2fcc9018&partnerID=40&md5=9a5bcafdd1e34db40974d82a228aa711 AN - rayyan-105238497 N1 -Cited By :128 Export Date: 28 September 2020 RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Critical Illness ER - TY - JOUR TI - Enhancing patient safety in the trauma/surgical intensive care unit AU - Stahl, K. AU - Palileo, A. AU - Schulman, C.I. AU - Wilson, K. AU - Augenstein, J. AU - Kiffin, C. AU - McKenney, M. T2 - Journal of Trauma - Injury, Infection and Critical Care AB - Background: Preventable deaths due to errors in trauma patients with otherwise survivable injuries account for up to 10% of fatalities in Level I trauma centers, 50% of these errors occur in the intensive care unit (ICU). The root cause of 67% of the Joint Commission sentinel events is communication errors. The objective is (1) to study how critical information degrades and how it is lost over 24 hours and (2) to determine whether a structured checklist for ICU handoffs prevents information loss. Methods: Prospective cohort study of trauma and surgical ICU teams observed with and without use of the checklist. An observational period (control group) was followed by a didactic session on the science and use of a checklist (study group), which was used for patient management and handoffs. Information was tracked for a 24-hour period and all handoffs. Comparisons use χ2 or Fisher's exact test and a p value <0.05 was defined as significant. Results: Three hundred and thirty-two patient ICU days were observed (119 control, 213 study) and 689 patient care items (303 control, 386 study) were followed. Seventy-five (10.9%) items were lost over 24 hours; 61 of 303 (20.1%) without checklist and 14 of 386 (3.6%) with checklist (p < 0.0001). Critical laboratory values and test results were the most frequent lost items (36.1% control vs. 4.5% study p < 0.0001). Six of 75 (8.1%) items were correctly ordered but not carried out by ICU nursing staff-all caught and corrected with checklist use. Conclusion: Critical information is degraded over 24 hours in the ICU. A structured checklist significantly reduces patient errors due to lost information and communication lapses between trauma ICU team members at handoffs of care. © 2009 by Lippincott Williams & Wilkins. DA - 2009/// PY - 2009 VL - 67 IS - 3 SP - 430 EP - 433 UR - https://www.scopus.com/inward/record.uri?eid=2-s2.0-70449122839&doi=10.1097%2fTA.0b013e3181acbe75&partnerID=40&md5=958df044dcfe03ce695bfd10d9f2bdbb AN - rayyan-105238504 N1 -Cited By :42 Export Date: 28 September 2020 RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Intensive Care Units ER - TY - JOUR TI - Critical care checklists, the keystone project, and the office for human research protections: A case for streamlining the approval process in quality-improvement research AU - Savel, R.H. AU - Goldstein, E.B. AU - Gropper, M.A. T2 - Critical Care Medicine AB - Checklists have been recently promulgated as a method to enhance patient safety and improve outcomes for critically ill patients. Specifically, recent work performed by researchers from the Johns Hopkins Medical Institutions has demonstrated that the addition of checklists to usual care in the intensive care unit is associated with a decrease in the incidence of catheter-related bloodstream infections. Initially evaluated at the institutional level, this effort has been successfully expanded to the state level as part of the Michigan Keystone Project. Although this work has recently received significant positive attention in the lay press, the Office for Human Research Protections-as they felt that this was a research project requiring Institutional Review Board approval and informed consent-put the data collection on hold for lack of approval by the Institutional Review Board at the participating hospitals in Michigan as well as for not having obtained informed consent from each patient and clinician involved in the project. This article documents the recent events surrounding the Keystone Project and the response to the actions taken by the Office for Human Research Protections in the lay press and the new media (Internet and blogs), articulates how a determination can be made if a project is quality-improvement, human-subjects research, or both, and proposes some solutions to create a structured approach to this kind of research in the future. © 2009 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins. DA - 2009/// PY - 2009 VL - 37 IS - 2 SP - 725 EP - 728 UR - https://www.scopus.com/inward/record.uri?eid=2-s2.0-67650389172&doi=10.1097%2fCCM.0b013e31819541f8&partnerID=40&md5=8a9b161ed71f7aeac3c984bfeb3cdbc8 AN - rayyan-105238506 N1 -Cited By :21 Export Date: 28 September 2020 RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Humans KW - Critical Care KW - Humanism KW - Humanities ER - TY - JOUR TI - Patient handover from surgery to intensive care: Using formula 1 pit-stop and aviation models to improve safety and quality AU - Catchpole, K.R. AU - De Leval, M.R. AU - Mcewan, A. AU - Pigott, N. AU - Elliott, M.J. AU - Mcquillan, A. AU - Macdonald, C. AU - Goldman, A.J. T2 - Paediatric Anaesthesia AB - Background: We aimed to improve the quality and safety of handover of patients from surgery to intensive care using the analogy of a Formula 1 pit stop and expertise from aviation. Methods: A prospective intervention study measured the change in performance before and after the implementation of a new handover protocol that was developed through detailed discussions with a Formula 1 racing team and aviation training captains. Fifty (23 before and 27 after) postsurgery patient handovers were observed. Technical errors and information omissions were measured using checklists, and teamwork was scored using a Likert scale. Duration of the handover was also measured. Results: The mean number of technical errors was reduced from 5.42 (95% CI ±1.24) to 3.15 (95% CI ±0.71), the mean number of information handover omissions was reduced from 2.09 (95% CI ±1.14) to 1.07 (95% CI ±0.55), and duration of handover was reduced from 10.8 min (95% CI ±1.6) to 9.4 min (95% CI ±1.29). Nine out of twenty-three (39%) precondition patients had more than one error in both technical and information handover prior to the new protocol, compared with three out of twnety-seven (11.5%) with the new handover. Regression analysis showed that the number of technical errors were significantly reduced with the new handover (t = -3.63, P < 0.001), and an interaction suggested that teamwork (t = 3.04, P = 0.004) had a different effect with the new handover protocol. Conclusions: The introduction of the new handover protocol lead to improvements in all aspects of the handover. Expertise from other industries can be extrapolated to improve patient safety, and in particular, areas of medicine involving the handover of patients or information. © 2007 The Authors. DA - 2007/// PY - 2007 VL - 17 IS - 5 SP - 470 EP - 478 UR - https://www.scopus.com/inward/record.uri?eid=2-s2.0-34247370984&doi=10.1111%2fj.1460-9592.2006.02239.x&partnerID=40&md5=c41e605fd54354e840cbc8ed8b61b644 AN - rayyan-105238511 N1 -Cited By :323 Export Date: 28 September 2020 RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Aviation ER - TY - JOUR TI - Development and implementation of an ICU quality improvement checklist AU - Simpson, S.Q. AU - Peterson, D.A. AU - O'Brien-Ladner, A.R. T2 - AACN Advanced Critical Care AB - Hospitals, especially their intensive care units, are not particularly safe for patients. Life-threatening mistakes and omissions in care can and do occur. To deter omissions and mistakes wherever possible, our medical intensive care team developed a checklist of care issues that must be addressed daily for every patient in our intensive care unit. The checklist augments our daily, multidisciplinary quality rounds and informs all personnel when important items have been missed. It is too soon to tell whether the checklist has had an impact on our survival rate or length of stay, but we have documented clear imrovement in our attention to these core intensive care issues. In addition, our team's collegiality and team bonding are enhanced by using an evidence-based tool to achieve our care goals. We share our checklist, so that others can use and/or adapt it in their pursuit of optimal care for their critically ill patiens. © 2007 Lippincott Williams & Wilkins, Inc. DA - 2007/// PY - 2007 VL - 18 IS - 2 SP - 183 EP - 189 UR - https://www.scopus.com/inward/record.uri?eid=2-s2.0-34250614726&doi=10.1097%2f01.AACN.0000269262.37288.bf&partnerID=40&md5=4465f7cfdf243b0feb1aca3e8188035b AN - rayyan-105238512 N1 -Cited By :24 Export Date: 28 September 2020 RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
ER - TY - JOUR TI - The checklist: if something so simple can transform intensive care, what else can it do? AU - Gawande, A. T2 - New Yorker (New York, N.Y. : 1925) DA - 2007/// PY - 2007 SP - 86 EP - 101 UR - https://www.scopus.com/inward/record.uri?eid=2-s2.0-38449085341&partnerID=40&md5=204607c3b3b7c56471fecca3ed5cf550 AN - rayyan-105238513 N1 -Cited By :116 Export Date: 28 September 2020 RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
ER - TY - JOUR TI - Safety culture and crisis resource management in airway management: General principles to enhance patient safety in critical airway situations AU - Rall, M. AU - Dieckmann, P. T2 - Best Practice and Research: Clinical Anaesthesiology AB - Airway management is a cornerstone of patient safety in anaesthesiology and in emergency and critical care medicine. Deficiencies in airway management could have catastrophic results for the patient. In anaesthesia patients, in particular, a high level of safety should be expected. It has been proven in other high-risk and complex industrial fields that obtaining very high levels of safety requires special strategies and safety philosophies in order to guarantee long-term low-risk production. The concept of safety culture has invaded many industries, more recently including medicine. Concepts of the high reliability organizations (HROs) are now ready to be adapted to medicine and offer promising improvements in health care. This paper applies some of the HRO principles to airway management and illustrates how to transform more general strategies to practical application in the clinical world. This includes the use of key elements of crisis resource management (CRM) and the development of a checklist for safety in airway management. © 2005 Elsevier Ltd. All rights reserved. DA - 2005/// PY - 2005 VL - 19 IS - 4 SP - 539 EP - 557 UR - https://www.scopus.com/inward/record.uri?eid=2-s2.0-29644441893&doi=10.1016%2fj.bpa.2005.07.005&partnerID=40&md5=ee990b04116a5f9c3f6ecc4ab3392c15 AN - rayyan-105238514 N1 -Cited By :53 Export Date: 28 September 2020 RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
ER - TY - JOUR TI - Real time patient safety audits: Improving safety every day AU - Ursprung, R. AU - Gray, J.E. AU - Edwards, W.H. AU - Horbar, J.D. AU - Nickerson, J. AU - Plsek, P. AU - Shiono, P.H. AU - Suresh, G.K. AU - Goldmann, D.A. T2 - Quality and Safety in Health Care AB - Background: Timely error detection including feedback to clinical staff is a prerequisite for focused improvement in patient safety. Real time auditing, the efficacy of which has been repeatedly demonstrated in industry, has not been used previously to evaluate patient safety. Methods successful at improving quality and safety in industry may provide avenues for improvement in patient safety. Objective: Pilot study to determine the feasibility and utility of real time safety auditing during routine clinical work in an intensive care unit (ICU). Methods: A 36 item patient safety checklist was developed via a modified Delphi technique. The checklist focused on errors associated with delays in care, equipment failure, diagnostic studies, information transfer and non-compliance with hospital policy. Safety audits were performed using the checklist during and after morning work rounds thrice weekly during the 5 week study period from January to March 2003. Results: A total of 338 errors were detected; 27 (75%) of the 36 items on the checklist detected ≥1 error. Diverse error types were found including unlabeled medication at the bedside (n = 31), ID band missing or in an inappropriate location (n = 70), inappropriate pulse oximeter alarm setting (n = 22), and delay in communication/information transfer that led to a delay in appropriate care (n = 4). Conclusions: Real time safety audits performed during routine work can detect a broad range of errors. Significant safety problems were detected promptly, leading to rapid changes in policy and practice. Staff acceptance was facilitated by fostering a blame free "culture of patient safety" involving clinical personnel in detection of remediable gaps in performance, and limiting the burden of data collection. DA - 2005/// PY - 2005 VL - 14 IS - 4 SP - 284 EP - 289 UR - https://www.scopus.com/inward/record.uri?eid=2-s2.0-23644453746&doi=10.1136%2fqshc.2004.012542&partnerID=40&md5=87d3eb7a7b0519d5850915f938778555 AN - rayyan-105238515 N1 -Cited By :74 Export Date: 28 September 2020 RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
ER - TY - JOUR TI - Using real time process measurements to reduce catheter related bloodstream infections in the intensive care unit AU - Wall, R.J. AU - Ely, E.W. AU - Elasy, T.A. AU - Dittus, R.S. AU - Foss, J. AU - Wilkerson, K.S. AU - Speroff, T. T2 - Quality and Safety in Health Care AB - Problem: Measuring a process of care in real time is essential for continuous quality improvement (CQI). Our inability to measure the process of central venous catheter (CVC) care in real time prevented CQI efforts aimed at reducing catheter related bloodstream infections (CR-BSIs) from these devices. Design: A system was developed for measuring the process of CVC care in real time. We used these new process measurements to continuously monitor the system, guide CQI activities, and deliver performance feedback to providers. Setting: Adult medical intensive care unit (MICU). Key measures for improvement: Measured process of CVC care in real time; CR-BSI rate and time between CR-BSI events; and performance feedback to staff. Strategies for change: An interdisciplinary team developed a standardized, user friendly nursing checklist for CVC insertion. Infection control practitioners scanned the completed checklists into a computerized database, thereby generating real time measurements for the process of CVC insertion. Armed with these new process measurements, the team optimized the impact of a multifaceted intervention aimed at reducing CR-BSIs. Effects of change: The new checklist immediately provided real time measurements for the process of CVC insertion. These process measures allowed the team to directly monitor adherence to evidence-based guidelines. Through continuous process measurement, the team successfully overcame barriers to change, reduced the CR-BSI rate, and improved patient safety. Two years after the introduction of the checklist the CR-BSI rate remained at a historic low. Lessons learnt: Measuring the process of CVC care in real time is feasible in the ICU. When trying to improve care, real time process measurements are an excellent tool for overcoming barriers to change and enhancing the sustainability of efforts. To continually improve patient safety, healthcare organizations should continually measure their key clinical processes in real time. DA - 2005/// PY - 2005 VL - 14 IS - 4 SP - 295 EP - 302 UR - https://www.scopus.com/inward/record.uri?eid=2-s2.0-23644434556&doi=10.1136%2fqshc.2004.013516&partnerID=40&md5=45fb94e635fc5981fd17996047b90473 AN - rayyan-105238516 N1 -Cited By :49 Export Date: 28 September 2020 RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Intensive Care Units KW - Process Assessment (Health Care) ER - TY - JOUR TI - Eliminating catheter-related bloodstream infections in the intensive care unit AU - Berenholtz, S.M. AU - Pronovost, P.J. AU - Lipsett, P.A. AU - Hobson, D. AU - Earsing, K. AU - Parley, J.E. AU - Milanovich, S. AU - Garrett-Mayer, E. AU - Winters, B.D. AU - Rubin, H.R. AU - Dorman, T. AU - Perl, T.M. T2 - Critical Care Medicine AB - Objective: To determine whether a multifaceted systems intervention would eliminate catheter-related bloodstream infections (PR-BSIs). Design: Prospective cohort study in a surgical intensive care unit (ICU) with a concurrent control IGU. Setting: The Johns Hopkins Hospital. Patients: All patients with a central venous catheter in the ICU. Intervention: To eliminate CR-BSIs, a quality improvement team implemented five interventions: educating the staff; creating a catheter insertion cart; asking providers daily whether catheters could be removed; implementing a checklist to ensure adherence to evidence-based guidelines for preventing CR-BSIs; and empowering nurses to stop the catheter insertion procedure if a violation of the guidelines was observed. Measurement: The primary outcome variable was the rate of CH-BSIs per 1,000 catheter days from January 1,1938, through December 31, 2002. Secondary outcome variables included adherence to evidence-based infection control guidelines during catheter insertion. Main Results: Before the intervention, we found that physicians followed infection control guidelines during 62% of the procedures. During the intervention time period, the CR-BSI rate in the study IGU decreased from 11.3/1,000 catheter days in the first quarter of 1938 to 0/1,000 catheter days in the fourth quarter of 2002. The CR-BSI rate in the control ICU was 5.7/1,000 catheter days in the first quarter of 1998 and 1.6/1,000 catheter days in the fourth quarter of 2002 (p = .56). We estimate that these interventions may have prevented 43 CR-BSIs, eight deaths, and $1,945,322 in additional costs per year in the study ICU. Conclusions: Multifaceted interventions that helped to ensure adherence with evidence-based infection control guidelines nearly eliminated CR-BSIs in our surgical ICU. DA - 2004/// PY - 2004 VL - 32 IS - 10 SP - 2014 EP - 2020 UR - https://www.scopus.com/inward/record.uri?eid=2-s2.0-5644300386&doi=10.1097%2f01.CCM.0000142399.70913.2F&partnerID=40&md5=6c9836a283099818a1b7e15d3662a903 AN - rayyan-105238518 N1 -Cited By :693 Export Date: 28 September 2020 RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Intensive Care Units ER - TY - JOUR TI - Long-term prevention of catheter-associated urinary tract infections among critically ill patients through the implementation of an educational program and a daily checklist for maintenance of indwelling urinary catheters: A quasi-experimental study. AU - Menegueti MG AU - Ciol MA AU - Bellissimo-Rodrigues F AU - Auxiliadora-Martins M AU - Gaspar GG AU - Canini SRMDS AU - Basile-Filho A AU - Laus AM T2 - Medicine AB - BACKGROUND: Removing an indwelling urinary catheter as soon as possible is the cornerstone of catheter-associated urinary tract infections (CAUTI) prevention. However, implementing this measure may be challenging in clinical settings. To evaluate the impact of implementing a healthcare workers (HCWs) educational program and a daily checklist for indwelling urinary catheter indications among critical patients on the incidence of CAUTI. METHODS: This was a quasi-experimental study performed in a general intensive care unit of a tertiary-care hospital over a 12 years period, from January 1, 2005 to December 31, 2016. Rates of urinary catheter use and incidence density of CAUTI were monthly evaluated following the Centers for Disease Control and Prevention (CDC) criteria throughout the study period. Phase I (2005-2006) was the pre-intervention period. In phase II (2007-2010), HCWs routine training on CAUTI prevention was performed twice-a-year. In phase III (2011-2014), we implemented a daily checklist for indwelling urinary catheter indications, in addition to the biannual training. In phase IV, (2015-2016) the biannual training was replaced by training only newly hired HCWs and the daily checklist was maintained. RESULTS: The mean rate of urinary catheter utilization decreased from phase I to phase IV (73.1%, 74.1%, 54.9%, and 45.6%, respectively). Similarly, the incidence density of CAUTI decreased from phase I to phase IV (14.9, 7.3, 3.8, and 1.1 per 1000 catheter-days, respectively). CONCLUSIONS: HCWs education and daily evaluation of indwelling urinary catheter indications were highly effective in reducing the rates of catheter utilization as well as the incidence density of CAUTI. DA - 2019/// PY - 2019 VL - 98 IS - 8 SP - e14417 J2 - Medicine (Baltimore) LA - eng SN - 1536-5964 (Electronic) UR - https://pubmed.ncbi.nlm.nih.gov/30813142/ AN - 30813142 Y2 - 0002/01/02/ N1 -RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Humans KW - Incidence KW - Critical Illness KW - Brazil KW - Catheter-Related Infections/epidemiology/*prevention & control KW - Checklist/methods KW - Critical Illness/therapy KW - Health Personnel/*education KW - Infection Control/*methods KW - Intensive Care Units/standards KW - Non-Randomized Controlled Trials as Topic KW - Program Evaluation/methods KW - Urinary Catheterization/adverse effects KW - Urinary Catheters/*adverse effects/statistics & numerical data KW - Urinary Tract Infections KW - Urinary Tract Infections/epidemiology/etiology/*prevention & control ER - TY - JOUR TI - A comprehensive method to develop a checklist to increase safety of intra-hospital transport of critically ill patients. AU - Brunsveld-Reinders AH AU - Arbous MS AU - Kuiper SG AU - de Jonge E T2 - Critical care (London, England) AB - INTRODUCTION: Transport of critically ill patients from the Intensive Care Unit (ICU) to other departments for diagnostic or therapeutic procedures is often a necessary part of the critical care process. Transport of critically ill patients is potentially dangerous with up to 70% adverse events occurring. The aim of this study was to develop a checklist to increase safety of intra-hospital transport (IHT) in critically ill patients. METHOD: A three-step approach was used to develop an IHT checklist. First, various databases were searched for published IHT guidelines and checklists. Secondly, prospectively collected IHT incidents in the LUMC ICU were analyzed. Thirdly, interviews were held with physicians and nurses over their experiences of IHT incidents. Following this approach a checklist was developed and discussed with experts in the field. Finally, feasibility and usability of the checklist was tested. RESULTS: Eleven existing guidelines and five checklists were found. Only one checklist covered all three phases: pre-, during- and post-transport. Recommendations and checklist items mostly focused on the pre-transport phase. Documented incidents most frequently related to patient physiology and equipment malfunction and occurred most often during transport. Discussing the incidents with ICU physicians and ICU nurses resulted in important recommendations such as the introduction of a standard checklist and improved communication with the other departments. This approach resulted in a generally applicable checklist, adaptable for local circumstances. Feedback from nurses using the checklist were positive, the fill in time was 4.5 minutes per phase. CONCLUSION: A comprehensive way to develop an intra-hospital checklist for safe transport of ICU patients to another department is described. This resulted in a checklist which is a framework to guide physicians and nurses through intra-hospital transports and provides a continuity of care to enhance patient safety. Other hospitals can customize this checklist to their own situation using the methods proposed in this paper. DA - 2015/// PY - 2015 VL - 19 IS - 1 SP - 214 J2 - Crit Care LA - eng SN - 1466-609X (Electronic) UR - https://pubmed.ncbi.nlm.nih.gov/25947327/ AN - 25947327 Y2 - 0005/01/02/ N1 -RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Humans KW - Critical Illness KW - Checklist/methods/*standards KW - Critical Illness/*therapy KW - Intensive Care Units/*standards KW - Patient Safety/*standards KW - Transportation of Patients/methods/*standards ER - TY - JOUR TI - A Multidisciplinary Handoff Process to Standardize the Transfer of Care Between the Intensive Care Unit and the Operating Room. AU - Karamchandani K AU - Fitzgerald K AU - Carroll D AU - Trauger ME AU - Ciccocioppo LA AU - Hess W AU - Prozesky J AU - Armen SB T2 - Quality management in health care AB - OBJECTIVE: Critically ill patients are at high risk for adverse events on transfer between intensive care unit and operating room. Patient safety concerns were raised within our institution during such transfers, and absence of a standardized patient handoff process was identified as an area of concern. METHODS: The current state of the patient transfer processes between the intensive care units (ICUs) and the operating rooms (ORs) was mapped and failure modes were identified. A multidisciplinary team was convened and a standardized handoff process and tool (checklist) was developed. Adherence to the process and care team satisfaction was assessed at the end of a 60-day pilot period. RESULTS: The process was successfully implemented hospital-wide covering all adult and pediatric ICUs. We observed a 90% compliance rate with ICU to the OR transfers and 95% compliance rate with transfers from OR to the ICU during the 60-day pilot period. The care team expressed overall satisfaction with the process and identified potential areas of improvement. CONCLUSION: A standardized patient handoff process between the ICU and the ORs can be successfully implemented in a large academic medical center. Universal application of this quality improvement tool can reduce patient harm, improve communication between providers, and enhance patient safety. DA - 2018/// PY - 2018 VL - 27 IS - 4 SP - 215 EP - 222 J2 - Qual Manag Health Care LA - eng SN - 1550-5154 (Electronic) UR - https://pubmed.ncbi.nlm.nih.gov/30260929/ AN - 30260929 N1 -RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Humans KW - Intensive Care Units KW - Critical Illness KW - Academic Medical Centers KW - Attitude of Health Personnel KW - Checklist/*standards KW - Communication KW - Hospital Bed Capacity, 500 and over KW - Intensive Care Units/*organization & administration/standards KW - Operating Rooms/*organization & administration/standards KW - Patient Handoff/*organization & administration/standards KW - Patient Safety KW - Quality Improvement/*organization & administration/standards ER - TY - JOUR TI - Improving Communication Between Surgery and Critical Care Teams: Beyond the Handover. AU - Turner CJ AU - Haas B AU - Lee C AU - Brar S AU - Detsky ME AU - Munshi L T2 - American journal of critical care : an official publication, American Association of Critical-Care Nurses AB - BACKGROUND: Structured communication tools for postoperative surgical handover to the intensive care unit (ICU) have shown promise, yet little work has addressed ongoing daily communication between the surgery and ICU teams thereafter. OBJECTIVES: Evaluation of a novel, 2-part communication intervention between surgery and ICU teams focused on postoperative handover and ongoing daily communication. METHODS: A mixed-methods, pre- and postintervention survey study was conducted in a closed quaternary medical-surgical ICU. Study participants (N = 112) included ICU physicians, nurses, allied health professionals, and physicians on the surgical team. The intervention consisted of a handover checklist completed postoperatively on arrival in the ICU and a 5-item communication tool completed daily by the surgical team. RESULTS: Satisfaction improved significantly in the following areas: postoperative handover communication (P < .001), daily communication (P = .001), understanding the postoperative plan (P < .001), initiation of deep vein thrombosis prophylaxis (P = .008), initiation of feeding (P = .009), and daily primary resident contact (P = .008). No significant improvement was seen in communication regarding disposition or overall improvement in patient safety risk from communication errors. CONCLUSIONS: A simple handover checklist improved health care practitioner satisfaction with communication during postoperative handover to the ICU. Concise daily communication tools are an appropriate option for improving ongoing communication between surgeons and the ICU team thereafter. DA - 2018/// PY - 2018 VL - 27 IS - 5 SP - 392 EP - 397 J2 - Am J Crit Care LA - eng SN - 1937-710X (Electronic) UR - https://pubmed.ncbi.nlm.nih.gov/30173172/ AN - 30173172 Y2 - 0009/01/02/ N1 -RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Humans KW - Prospective Studies KW - Critical Care KW - Attitude of Health Personnel KW - *Checklist KW - *Communication KW - *Intensive Care Units KW - *Patient Handoff KW - Patient Care Team KW - Postoperative Period KW - Quality Improvement ER - TY - JOUR TI - The Handover from Intensive Care Unit to General Ward: Baseline Performance and Participatory Design of an Electronic Follow-Up Plan. AU - Østergaard KL AU - Simonsen J AU - Hertzum M T2 - Studies in health technology and informatics AB - The transfer of patients from intensive care unit (ICU) to general ward involves risk to patient health. To mitigate this risk the present study investigates the current use of follow-up plans in the handover from ICU to general ward and proposes a novel design of follow-up plans. On the basis of a record audit we find that follow-up plans exist for only 16% of the audited transfers, that these plans are rarely used, and that 25% of the patients with a plan die within 24 hours of their transfer. In a subsequent series of participatory-design workshops with ICU and ward nurses we devised an electronic follow-up plan that consists of an attend-to list rather than a checklist. The attend-to list specifies the issues of concern but leaves the process of attaining them for the general-ward nurses to decide, thereby acknowledging and utilizing their expertise. DA - 2019/// PY - 2019 VL - 264 SP - 1303 EP - 1307 J2 - Stud Health Technol Inform LA - eng SN - 1879-8365 (Electronic) UR - https://pubmed.ncbi.nlm.nih.gov/31438136/ AN - 31438136 Y2 - 0008/01/02/ N1 -RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Humans KW - Follow-Up Studies KW - Intensive Care Units KW - *Patient Handoff KW - *Patients' Rooms KW - Checklist ER - TY - JOUR TI - The difference in hand hygiene compliance rate between unit-based observers and trained observers for World Health Organization checklist and optimal hand hygiene. AU - Baek EH AU - Kim SE AU - Kim DH AU - Cho OH AU - Hong SI AU - Kim S T2 - International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases AB - BACKGROUND: Hand hygiene (HH) is crucial to prevent healthcare-associated infections and the spread of multidrug-resistant organisms. The monitoring of HH compliance may be affected by observer expertise. A sufficient duration of HH is necessary to remove microorganisms. The aim of this study was to measure compliance with both the World Health Organization (WHO) checklist and optimal HH as reported by unit-based observers and infection control nurses (ICN). METHODS: Optimal HH was defined as adhering to the exact duration and following a six-step procedure. The disparity in compliance with the WHO checklist and optimal HH was analyzed among each profession, unit, and indication, covering a period of 3 years. RESULTS: There was a statistically significant difference in WHO checklist compliance (94.4% vs. 87.0%, p<0.01) and optimal HH rate (86.3% vs. 42.4%, p<0.01) between unit-based observers and ICN. The optimal HH rate was especially lower for doctors (30.1%), in the intensive care units (39.4%), and before clean and aseptic procedures (37.0%) as observed by ICN. CONCLUSIONS: Although the overall WHO checklist HH rate was reported to be higher than 90%, optimal HH was only half this rate. More education and awareness of the significance of HH, as well as adherence to the optimal HH procedures, are needed to prevent hospital-acquired infections. DA - 2020/// PY - 2020 VL - 90 SP - 197 EP - 200 J2 - Int J Infect Dis LA - eng SN - 1878-3511 (Electronic) UR - https://pubmed.ncbi.nlm.nih.gov/31605810/ AN - 31605810 Y2 - 0001/01/02/ N1 -RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Humans KW - Intensive Care Units KW - Checklist KW - *Guideline Adherence KW - Cross Infection/*prevention & control KW - Hand KW - Hand Hygiene/methods/*standards KW - Hygiene KW - Infection Control/methods/standards KW - Physicians/statistics & numerical data KW - World Health Organization ER - TY - JOUR TI - Organizational factors associated with target sedation on the first 48 h of mechanical ventilation: an analysis of checklist-ICU database. AU - Nassar AP Jr AU - Zampieri FG AU - Salluh JI AU - Bozza FA AU - Machado FR AU - Guimarães HP AU - Damiani LP AU - Cavalcanti AB T2 - Critical care (London, England) AB - BACKGROUND: Although light sedation levels are associated with several beneficial outcomes for critically ill patients on mechanical ventilation, the majority of patients are still deeply sedated. Organizational factors may play a role on adherence to light sedation levels. We aimed to identify organizational factors associated with a moderate to light sedation target on the first 48 h of mechanical ventilation, as well as the association between early achievement of within-target sedation and mortality. METHODS: This study is a secondary analysis of a multicenter two-phase study (prospective cohort followed by a cluster-randomized controlled trial) performed in 118 Brazilian ICUs. We included all critically ill patients who were on mechanical ventilation 48 h after ICU admission. A moderate to light level of sedation or being alert and calm (i.e., the Richmond Agitation-Sedation Scale of - 3 to 0) was the target for all patients on mechanical ventilation during the study period. We collected data on the type of hospital (public, private, profit and private, nonprofit), hospital teaching status, nursing and physician staffing, and presence of sedation, analgesia, and weaning protocols. We used multivariate random-effects regression with ICU and study phase as random-effects and correction for patients' Simplified Acute Physiology Score 3 and Sequential Organ Failure Assessment. We also performed a mediation analysis to explore whether sedation level was just a mediator of the association between organizational factors and mortality. RESULTS: We included 5719 patients. Only 1710 (29.9%) were on target sedation levels on day 2. Board-certified intensivists on the morning and afternoon shifts were associated with an adequate sedation level on day 2 (OR = 2.43; CI 95%, 1.09-5.38). Target sedation levels were associated with reduced hospital mortality (OR = 0.63; CI 95%, 0.55-0.72). Mediation analysis also suggested such an association, but did not suggest a relationship between the physician staffing model and hospital mortality. CONCLUSIONS: Board-certified intensivists on morning and afternoon shifts were associated with an increased number of patients achieving lighter sedation goals. These findings reinforce the importance of organizational factors, such as intensivists' presence, as a modifiable quality improvement target. DA - 2019/// PY - 2019 VL - 23 IS - 1 SP - 34 J2 - Crit Care LA - eng SN - 1466-609X (Electronic) UR - https://pubmed.ncbi.nlm.nih.gov/30696474/ AN - 30696474 Y2 - 0001/01/02/ N1 -RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Humans KW - Adult KW - Female KW - Male KW - Aged KW - Middle Aged KW - Prospective Studies KW - Length of Stay KW - Brazil KW - Checklist/*standards/statistics & numerical data KW - Cohort Studies KW - Conscious Sedation/methods KW - Deep Sedation/*methods KW - Hospital Mortality KW - Hypnotics and Sedatives/adverse effects/therapeutic use KW - Intensive Care Units/organization & administration/statistics & numerical data KW - Logistic Models KW - Organ Dysfunction Scores KW - Respiration, Artificial KW - Respiration, Artificial/*methods/mortality KW - Simplified Acute Physiology Score KW - Ventilators, Mechanical ER - TY - JOUR TI - Efficacy of introducing a checklist to reduce central venous line associated bloodstream infections in the ICU caring for adult patients. AU - Wichmann D AU - Belmar Campos CE AU - Ehrhardt S AU - Kock T AU - Weber C AU - Rohde H AU - Kluge S T2 - BMC infectious diseases AB - BACKGROUND: Central line-associated bloodstream infections (CLABSI) are a major source of sepsis in modern intensive care medicine. Some years ago bundle interventions have been introduced to reduce CLABSI. The use of checklists may be an additional tool to improve the effect of these bundles even in highly specialized institutions. In this study we investigate if the introduction of a checklist reduces the frequency of CLABSI. METHODS: During the study period from October 2011 to September 2012, we investigated the effect of implementing a checklist for the placement of central venous lines (CVL). Patients were allocated either to the checklist group or to the control group, roughly in a 1:2 ratio. The frequency of CLABSI was compared between the two groups. RESULTS: During the study period 4416 CVL were inserted; 1518 in the checklist group and 2898 in the control group. The use of the checklist during CVL placement resulted in a lower CLABSI frequency. The incidence in the checklist group was 3.8 per 1000 catheter days as compared to 5.9 per 1000 catheter days in the control group (IRR = 0.57; p = 0.001). The use of the checklist also reduced the frequency of catheter colonisation significantly, 36.3 per 1000 catheter days in the checklist group vs 21.2 per 1000 catheter days in the control group, respectively (IRR = 0.58; p < 0.001). CONCLUSION: The introduction of a checklist to improve the adherence to hygiene standards while placement of central venous lines reduced the frequency of infections significantly. DA - 2018/// PY - 2018 VL - 18 IS - 1 SP - 267 J2 - BMC Infect Dis LA - eng SN - 1471-2334 (Electronic) UR - https://pubmed.ncbi.nlm.nih.gov/29884118/ AN - 29884118 Y2 - 0006/01/02/ N1 -RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Humans KW - Adult KW - Female KW - Male KW - Incidence KW - Intensive Care Units KW - *Checklist KW - Bacteria/chemistry/isolation & purification/metabolism KW - Case-Control Studies KW - Catheter-Related Infections/epidemiology/microbiology/*prevention & control KW - Catheterization, Central Venous KW - Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization ER - TY - JOUR TI - Laboratory Tests and X-ray Imaging in a Surgical Intensive Care Unit: Checking the Checklist. AU - Yorkgitis BK AU - Loughlin JW AU - Gandee Z AU - Bates HH AU - Weinhouse G T2 - The Journal of the American Osteopathic Association AB - CONTEXT: Patients in the surgical intensive care unit (ICU) frequently undergo laboratory and imaging testing. These tests can lead to iatrogenic anemia and radiation exposure. Many of these tests may be unnecessary for the management of a patient's illness in the surgical ICU, and their ordering may be a reflex rather than in response to a clinical question. Checklists have been used in critical care to identify and address patient care strategies. OBJECTIVE: To examine whether adding a "diagnostic testing" section to a daily checklist used for patient rounds in a surgical ICU would decrease the amount of laboratory tests and chest x-ray imaging ordered. METHODS: An additional section was added to an established ICU daily checklist, which included the following 2 questions: "Is a [chest x-ray] needed for clinical management tomorrow?" and "What laboratory tests are medically necessary for tomorrow?" Comparison was made between 3-month preintervention (control group) and intervention (intervention group) periods. Medical records of hospitalized patients during the preintervention and intervention periods were compared to determine differences in the number of tests ordered per day during each period. RESULTS: A total of 307 adult patients at a single institution were included in the analysis: 155 in the control group and 152 in the intervention group. The patients in each group were similar in terms of sex, age, Sequential Organ Failure scores, Charlson Comorbidity Index scores, elective admission status, surgical procedures, number of days of mechanical ventilation, ICU length of stay, and in-hospital death. No statistical reductions in laboratory tests or chest x-ray imaging ordered per day from the preintervention to intervention period were found. CONCLUSION: The addition of the diagnostic testing section to the daily checklist did not result in a reduction of the amount of tests ordered per day. Further research on test appropriateness and the possible addition of a clinician decision-making tool could be studied in the future to assist with reduction of tests ordered in the surgical ICU. DA - 2018/// PY - 2018 VL - 118 IS - 5 SP - 305 EP - 309 J2 - J Am Osteopath Assoc LA - eng SN - 1945-1997 (Electronic) UR - https://pubmed.ncbi.nlm.nih.gov/29710352/ AN - 29710352 Y2 - 0005/01/02/ N1 -RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Humans KW - Adult KW - Female KW - Male KW - Aged KW - Middle Aged KW - Intensive Care Units KW - *Checklist KW - *Intensive Care Units KW - *Quality Improvement KW - Clinical Laboratory Techniques/*statistics & numerical data KW - Diagnostic Tests, Routine/*statistics & numerical data KW - Procedures and Techniques Utilization KW - Radiography/*statistics & numerical data ER - TY - JOUR TI - Checklist as a Memory Externalization Tool during a Critical Care Process. AU - Sarcevic A AU - Zhang Z AU - Marsic I AU - Burd RS T2 - AMIA ... Annual Symposium proceedings. AMIA Symposium AB - We analyzed user interactions with a paper-based checklist in a regional trauma center to inform the design of digital cognitive aids for safety-critical medical teamwork. An initial review of paper checklists from actual trauma resuscitations revealed that trauma team leaders frequently wrote notes on the checklist. To understand this notetaking practice, we performed content analysis of 163 checklists collected over the period of four months. We found nine major categories of information that leaders recorded during resuscitations, including patient values, physical assessment findings, and pre-hospital information. An analysis of types and amount of notes written by leaders of different experience levels showed that more experienced leaders recorded more patient values and physical findings, while less experienced leaders recorded more notes about their activities and task completion status. These findings suggested that a checklist designed for a high-risk, fast-paced medical event has evolved into a dual function tool, serving both as a compliance and memory aid. Based on these findings, we derived requirements for designing digital cognitive aids to support safety-critical medical teamwork. DA - 2016/// PY - 2016 VL - 2016 SP - 1080 EP - 1089 J2 - AMIA Annu Symp Proc LA - eng SN - 1942-597X (Electronic) UR - https://pubmed.ncbi.nlm.nih.gov/28269905/ AN - 28269905 N1 -RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Humans KW - Critical Care KW - *Checklist KW - *Critical Care KW - *Resuscitation KW - Documentation KW - Memory KW - Physical Examination KW - Trauma Centers KW - Wounds and Injuries/diagnosis/*therapy ER - TY - JOUR TI - Checklists and cognitive aids in simulation training and daily critical care practice: Simple tools to improve medical performance and patient outcome. AU - Geeraerts T AU - Le Guen M T2 - Anaesthesia, critical care & pain medicine DA - 2018/// PY - 2018 VL - 37 IS - 1 SP - 3 EP - 4 J2 - Anaesth Crit Care Pain Med LA - eng SN - 2352-5568 (Electronic) UR - https://pubmed.ncbi.nlm.nih.gov/29362161/ AN - 29362161 Y2 - 0002/01/02/ N1 -RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Humans KW - Critical Care KW - *Checklist KW - *Malignant Hyperthermia KW - Cognition KW - Simulation Training ER - TY - JOUR TI - Intensive care unit readmission prevention checklist: is it worth the effort? AU - Smischney NJ AU - Cawcutt KA AU - O'Horo JC AU - Sevilla Berrios RA AU - Whalen FX T2 - Journal of evaluation in clinical practice AB - RATIONALE, AIMS AND OBJECTIVES: Checklists have been adopted by various institutions to improve patient outcomes. In particular, readmission prevention checklists may be of potential value to improve patient care and reduce medical costs. As a result, a prior quality improvement study was conducted to create an intensive care unit readmission prevention checklist. The previous pilot demonstrated zero readmissions when the readmission prevention checklist was utilized but yielded low compliance (30%). Thus, a subsequent quality initiative was undertaken to refine the readmission prevention checklist with the primary aim of improved compliance while maintaining a reduced readmission rate that was observed with the original quality improvement study. METHOD: A single-centre, cross-sectional study for assessing baseline data and a prospective observational study to assess the effectiveness of a refined readmission prevention checklist tool in a 20-bed tertiary medical-surgical intensive care unit at an academic medical centre in Rochester, MN was conducted. Medical patients admitted through the emergency department, upon direct transfer from outside facility, and post-operative surgical patients at our institution were included. A refined readmission prevention checklist tool was administered during an 8-week pilot period for medical and post-operative surgical patients. RESULTS: The refined readmission prevention checklist resulted in an even lower compliance (10.5%) from the initial phase likely resulting from utilization of a paper readmission prevention checklist in an electronic medical environment. Moreover, the refined readmission prevention checklist demonstrated a 22% unplanned readmission rate for patients in which the tool was utilized. CONCLUSIONS: In conclusion, the findings of the current quality improvement study may serve to rethink the process of health care delivery that applies paper tools in an electronic medical environment. DA - 2014/// PY - 2014 VL - 20 IS - 4 SP - 348 EP - 51 J2 - J Eval Clin Pract LA - eng SN - 1365-2753 (Electronic) UR - https://pubmed.ncbi.nlm.nih.gov/24779527/ AN - 24779527 Y2 - 0008/01/02/ N1 -RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Humans KW - Cross-Sectional Studies KW - Prospective Studies KW - Intensive Care Units KW - Academic Medical Centers KW - Checklist/*standards KW - *Intensive Care Units KW - *Patient Readmission KW - Intensive Care KW - Minnesota KW - Pilot Projects KW - Quality Assurance, Health Care KW - Surveys and Questionnaires ER - TY - JOUR TI - Improving the quality of the intensive care follow-up of ventilated patients during a national registration program. AU - Reper P AU - Dicker D AU - Damas P AU - Huyghens L AU - Haelterman M T2 - Public health AB - OBJECTIVES: The Belgian Public Health Organization is concerned with rates of hospital-acquired infections like ventilator-associated pneumonia (VAP). Implementing best practice guidelines for these nosocomial infections has variable success in the literature. This retrospective study was undertaken to see whether implementation of the evidence-based practices as a bundle was feasible, would influence compliance, and could reduce the rates of VAP. STUDY DESIGN: We utilized easily collectable data about regular care to rapidly assess whether interventions already in place were effectively successfully applied. This avoided cumbersome data collection and review. METHODS: Retrospective compliance rates and VAP ratios were compared using z tests with P-values < 0.05 considered statistically significant. This data review attempted to examine the impact of education campaigns, staff meetings, in-services, physician checklist, nurse checklist, charge nurse checklist implementation, systematic VAP bundle application, and systematic protocols for oral care and sedation protocols. Additionally, VAP ratio could be registered by the participating centers. RESULTS: A total of 10,211 intensive care unit (ICU) patients were included in the study which represents 66,817 ICU days under artificial ventilation with an endotracheal tube. The general compliance for VAP bundle raised from VAP was 61% in February 2012 and 74.16% in December 2012 (P < 0.001). The incidence rate of VAP went from 8.34 occurrences/1000 vent days in 2009 to 4.78 occurrences/1000 vent days in 2012 (P < 0.001-Pearson test). CONCLUSIONS: Efforts to improve physician and staff education, and checklist implementation resulted in an increase in compliance for VAP bundle and a decrease in VAP ratio. This study confirms the applicability of best practice guidelines about regular care but results on VAP incidence have to be confirmed. DA - 2017/// PY - 2017 VL - 148 SP - 159 EP - 166 J2 - Public Health LA - eng SN - 1476-5616 (Electronic) UR - https://pubmed.ncbi.nlm.nih.gov/28501761/ AN - 28501761 Y2 - 0007/01/02/ N1 -RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Humans KW - Retrospective Studies KW - Feasibility Studies KW - Checklist KW - Ventilators, Mechanical KW - *Quality Improvement KW - *Practice Guidelines as Topic KW - Belgium/epidemiology KW - Critical Care/*standards KW - Cross Infection/epidemiology/*prevention & control KW - Evidence-Based Practice/*organization & administration KW - Guideline Adherence/statistics & numerical data KW - Intensive Care Units/statistics & numerical data KW - Medical Staff, Hospital/*education KW - Pneumonia, Ventilator-Associated/epidemiology/*prevention & control KW - Program Evaluation KW - Registries KW - Respiration, Artificial/statistics & numerical data ER - TY - JOUR TI - Intensive care unit rounding checklist implementation. Effect of accountability measures on physician compliance. AU - Carlos WG AU - Patel DG AU - Vannostrand KM AU - Gupta S AU - Cucci AR AU - Bosslet GT T2 - Annals of the American Thoracic Society AB - RATIONALE/OBJECTIVES: Checklist utilization has been shown to improve multiple processes of care in the intensive care unit (ICU). The ICU setting makes checklist implementation challenging, particularly when prompters are unavailable to ensure checklist compliance. We performed a prospective analysis on physician compliance reporting as a means to improve attending physician compliance with checklist use during ICU rounds. METHODS: We performed a prospective analysis of 14 attending physicians' compliance with checklist use before and after accountability measures employed at two urban academic hospitals in the United States. The accountability measures were bimonthly publication of physician checklist compliance via division e-mail and during a multidisciplinary division conference. MEASUREMENTS AND MAIN RESULTS: A total of 5,812 patient days of ICU care were assessed from April 2013 through March 2014. Compliance with checklist use during ICU rounds improved at both academic hospitals during the intervention phase. Initial compliance rates were 67% at both institutions and subsequently improved to 90 and 81%, respectively, after accountability measures were employed. During a 3-month washout phase in which no public accountability measures were employed, compliance was maintained at 89 and 78% at the two hospitals. Foley catheter, central venous catheter, and ventilator utilization rates decreased after initiation of public accountability at both hospitals. CONCLUSIONS: Physician compliance reporting can be used to improve ICU physician compliance with rounding checklists when prompters are unavailable. Improved physician compliance translated into decreased rates of Foley catheter, central venous catheter, and ventilator use. These results highlight the impact physician accountability can have on patient care in the ICU. DA - 2015/// PY - 2015 VL - 12 IS - 4 SP - 533 EP - 8 J2 - Ann Am Thorac Soc LA - eng SN - 2325-6621 (Electronic) UR - https://pubmed.ncbi.nlm.nih.gov/25642750/ AN - 25642750 Y2 - 0004/01/02/ N1 -RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Humans KW - Prospective Studies KW - Intensive Care Units KW - Academic Medical Centers KW - *Intensive Care Units KW - Quality Improvement KW - Intensive Care KW - Critical Care/*standards KW - Respiration, Artificial/statistics & numerical data KW - *Disclosure KW - *Medical Staff, Hospital KW - Central Venous Catheters/statistics & numerical data KW - Checklist/*methods KW - Quality of Health Care KW - Social Responsibility KW - Teaching Rounds/*methods KW - Urinary Catheters/statistics & numerical data ER - TY - JOUR TI - Validating a process-of-care checklist for intensive care units. AU - Conroy KM AU - Elliott D AU - Burrell AR T2 - Anaesthesia and intensive care AB - Early evidence suggests that checklists are one way of ensuring required processes of care are delivered to intensive care unit patients. Evidence to date however, has not explicitly detailed methods of checklist validation in these settings. This study aimed to test the validity of a 'process-of-care' checklist for measuring and ensuring daily care delivery in an intensive care unit. A retrospective audit of a random selection of patient medical records was undertaken to compare with checklist data completed during the same time frame. Documentation in the patients' medical records was used as a proxy measure for actual completion of care. A specific audit tool extracted information from both the checklist and the medical record on the following processes of care: nutrition, weaning from ventilation, pain, glucose control, sit out of bed, bowel management, deep vein thrombosis and stress ulcer prophylaxis. These two data sources were compared using the Spearman's rho correlation coefficient. The two forms of documentation were significantly correlated (P=0.01) for all but one of the checklist items (pain). Findings provided support for the concurrent validity of an intensive care unit process-of-care checklist. Further research is required for checklist validity and reliability testing prior to, or in conjunction with, a planned prospective intervention study. DA - 2013/// PY - 2013 VL - 41 IS - 3 SP - 342 EP - 8 J2 - Anaesth Intensive Care LA - eng SN - 0310-057X (Print) UR - https://pubmed.ncbi.nlm.nih.gov/23659396/ AN - 23659396 Y2 - 0005/01/02/ N1 -RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Humans KW - Female KW - Male KW - Retrospective Studies KW - Middle Aged KW - Intensive Care Units KW - Length of Stay KW - *Checklist KW - Documentation KW - APACHE KW - Australia KW - Critical Care/methods/standards KW - Data Collection KW - Demography KW - Intensive Care Units/*organization & administration KW - Reproducibility of Results ER - TY - JOUR TI - Decreasing failed extubations with the implementation of an extubation checklist. AU - Bobbs M AU - Trust MD AU - Teixeira P AU - Coopwood B AU - Aydelotte J AU - Tabas I AU - Ali S AU - Brown CVR T2 - American journal of surgery AB - BACKGROUND: Failed extubation has been shown to increase ICU stay, transfers to rehabilitation facilities, and mortality. The purpose of this study was to assess the differences in rates of failed extubation before and after implementation of an extubation checklist. METHODS: We performed a retrospective study from January 2013-April 2017 on adult trauma patients (age 18-89) who were admitted to the ICU and required mechanical ventilation. Patients were grouped before and after implementation of an extubation checklist and compared. RESULTS: A total of 993 patients were included in this study. After checklist implementation, significantly fewer patients required reintubation compared to those prior to checklist (7% vs 3%, p = 0.005). There was no difference in mortality (20% vs 21%, p = 0.54) or hospital length of stay between the two groups (16 days vs 15 days, p = 0.16). CONCLUSION: Our study reveals that implementing an extubation checklist is associated with fewer failed extubations. DA - 2019/// PY - 2019 VL - 217 IS - 6 SP - 1072 EP - 1075 J2 - Am J Surg LA - eng SN - 1879-1883 (Electronic) UR - https://pubmed.ncbi.nlm.nih.gov/30890263/ AN - 30890263 Y2 - 0006/01/02/ N1 -RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Humans KW - Adult KW - Female KW - Male KW - Treatment Outcome KW - Retrospective Studies KW - Aged KW - Middle Aged KW - Adolescent KW - Intensive Care Units KW - *Checklist KW - Aged, 80 and over KW - Airway Extubation/methods/mortality/*standards/statistics & numerical data KW - Length of Stay/statistics & numerical data KW - Ventilator Weaning/methods/mortality/*standards/statistics & numerical data KW - Wounds and Injuries/mortality/*therapy KW - Young Adult ER - TY - JOUR TI - Creation of the Prevention of Organ Failure Checklist. A Multidisciplinary Approach Using the Modified Delphi Technique. AU - Pearl JS AU - Gajic O AU - Dong Y AU - Herasevich V AU - Gong MN T2 - Annals of the American Thoracic Society AB - RATIONALE: 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. OBJECTIVES: 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. METHODS: 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. MEASUREMENTS AND MAIN RESULTS: 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. CONCLUSIONS: 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. DA - 2016/// PY - 2016 VL - 13 IS - 6 SP - 910 EP - 6 J2 - Ann Am Thorac Soc LA - eng SN - 2325-6621 (Electronic) UR - https://pubmed.ncbi.nlm.nih.gov/26933899/ AN - 26933899 Y2 - 0006/01/02/ N1 -RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Humans KW - Intensive Care Units KW - Critical Illness/*therapy KW - *Checklist KW - Respiration, Artificial KW - Critical Care/*standards KW - *Organ Dysfunction Scores KW - Consensus KW - Delphi Technique KW - Expert Testimony KW - Respiratory Insufficiency/*diagnosis/therapy KW - United States ER - TY - JOUR TI - Safety First! Using a Checklist for Intrafacility Transport of Adult Intensive Care Patients. AU - Comeau OY AU - Armendariz-Batiste J AU - Woodby SA T2 - Critical care nurse AB - BACKGROUND: Adult critical care patients in an academic medical center experienced adverse events during intrafacility transport resulting from lack of preparation. An intervention was needed to help keep patients safe during intrafacility transport. OBJECTIVE: To develop a checklist for transport that is easy to use and effective in preparing patients for transport. METHOD: A checklist was developed and implemented. Elements of the checklist include preparation of the patient before transport, screening of patients for criteria that may place them at higher risk during transport, and a checklist for the procedural site. RESULTS: From May 2011 through July 2014, 2506 transports were conducted. Of these, 97.6% (n = 2445) involved no reported complications. CONCLUSION: This tool is suitable for bedside clinicians to use when preparing patients for transport. DA - 2015/// PY - 2015 VL - 35 IS - 5 SP - 16 EP - 25 J2 - Crit Care Nurse LA - eng SN - 1940-8250 (Electronic) UR - https://pubmed.ncbi.nlm.nih.gov/26427972/ AN - 26427972 Y2 - 0010/01/02/ N1 -RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Humans KW - Adult KW - Male KW - Middle Aged KW - *Checklist KW - *Critical Care KW - *Patient Safety KW - Patient Transfer/*methods/standards KW - Practice Guidelines as Topic ER - TY - JOUR TI - Successful introduction of a daily checklist to enhance compliance with accepted standards of care in the medical intensive care unit. AU - Nama A AU - Sviri S AU - Abutbul A AU - Stav I AU - van Heerden PV T2 - Anaesthesia and intensive care AB - We introduced a simple checklist to act as an aid to memory for our junior medical staff to ensure that every patient in the intensive care unit (ICU) received every appropriate element of a bundle of care every day. The checklist was developed in consultation with our junior doctors and was designed to be completed every morning for every patient by the junior doctor reviewing the patient. The completed checklist was then checked again by the attending intensivist on the main daily ward round to ensure all the appropriate elements of the checklist had been applied to the patient. It was also noted each day which of the elements of the checklist had been forgotten and was therefore prompted to be completed by use of the checklist. Of the 75 patients surveyed there were 99 occasions, in 48 patients, when the checklist detected a forgotten element of the bundle of care (i.e. in 64% of patients). There was a decrease in the incidence of missed elements of the bundle of care the longer the patient stayed in the ICU. Types of missed elements varied with the duration of the ICU stay. We found that the introduction of a simple checklist, developed in collaboration with the junior medical staff who would be using the checklist every day in the ICU, resulted in the detection and correction of missed elements of a bundle of care we had previously introduced in the ICU. DA - 2016/// PY - 2016 VL - 44 IS - 4 SP - 498 EP - 500 J2 - Anaesth Intensive Care LA - eng SN - 0310-057X (Print) UR - https://pubmed.ncbi.nlm.nih.gov/27456181/ AN - 27456181 Y2 - 0007/01/02/ N1 -RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Humans KW - Adult KW - Female KW - Male KW - Aged KW - Middle Aged KW - *Checklist KW - *Intensive Care Units KW - Aged, 80 and over KW - *Standard of Care KW - Cooperative Behavior ER - TY - JOUR TI - The "ABCs" of critical care teamwork: Introduction of a practical checklist. AU - Brindley PG AU - Tuma M AU - Vachhrajani J AU - Lefkimmiatis C AU - White K AU - Pronovost A AU - Baker AJ T2 - Journal of critical care DA - 2016/// PY - 2016 VL - 33 SP - 277 EP - 8 J2 - J Crit Care LA - eng SN - 1557-8615 (Electronic) UR - https://pubmed.ncbi.nlm.nih.gov/26972844/ AN - 26972844 Y2 - 0006/01/02/ N1 -RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Humans KW - Feedback KW - *Checklist KW - Crisis Intervention KW - Critical Care/*organization & administration KW - Medical Errors/prevention & control KW - Patient Care Team/*organization & administration ER - TY - JOUR TI - A cluster randomized trial of a multifaceted quality improvement intervention in Brazilian intensive care units: study protocol. AU - Machado F AU - Bozza F AU - Ibrain J AU - Salluh F AU - Campagnucci VP AU - Guimarães HP AU - Normilio-Silva K AU - Chiattone VC AU - Vendramim P AU - Carrara F AU - Lubarino J AU - da Silva AR AU - Viana G AU - Damiani LP AU - Romano E AU - Teixeira C AU - da Silva NB AU - Chang CC AU - Angus DC AU - Berwanger O T2 - Implementation science : IS AB - BACKGROUND: The uptake of evidence-based therapies in the intensive care environment is suboptimal, particularly in limited-resource countries. Checklists, daily goal assessments, and clinician prompts may improve compliance with best practice processes of care and, in turn, improve clinical outcomes. However, the available evidence on the effectiveness of checklists is unreliable and inconclusive, and the mechanisms are poorly understood. We aim to evaluate whether the use of a multifaceted quality improvement intervention, including the use of a checklist and the definition of daily care goals during multidisciplinary daily rounds and clinician prompts, can improve the in-hospital mortality of patients admitted to intensive care units (ICUs). Our secondary objectives are to assess the effects of the study intervention on specific processes of care, clinical outcomes, and the safety culture and to determine which factors (the processes of care and/or safety culture) mediate the effect of the study intervention on mortality. METHODS/DESIGN: This is a cluster randomized trial involving 118 ICUs in Brazil conducted in two phases. In the observational preparatory phase, we collect baseline data on processes of care and clinical outcomes from 60 consecutive patients with lengths of ICU stay longer than 48 h and apply the Safety Attitudes Questionnaire (SAQ) to 75% or more of the health care staff in each ICU. In the randomized phase, we assign ICUs to the experimental or control arm and repeat data collection. Experimental arm ICUs receive the multifaceted quality improvement intervention, including a checklist and definition of daily care goals during daily multidisciplinary rounds, clinician prompting, and feedback on rates of adherence to selected care processes. Control arm ICUs maintain usual care. The primary outcome is in-hospital mortality, truncated at 60 days. Secondary outcomes include the rates of adherence to appropriate care processes, rates of other clinical outcomes, and scores on the SAQ domains. Analysis follows the intention-to-treat principle, and the primary outcome is analyzed using mixed effects logistic regression. DISCUSSION: This is a large scale, pragmatic cluster-randomized trial evaluating whether a multifaceted quality improvement intervention, including checklists applied during the multidisciplinary daily rounds and clinician prompting, can improve the adoption of proven therapies and decrease the mortality of critically ill patients. If this study finds that the intervention reduces mortality, it may be widely adopted in intensive care units, even those in limited-resource settings. TRIAL REGISTRATION: ClinicalTrials.gov NCT01785966. DA - 2015/// PY - 2015 VL - 10 SP - 8 J2 - Implement Sci LA - eng SN - 1748-5908 (Electronic) UR - https://pubmed.ncbi.nlm.nih.gov/25928627/ AN - 25928627 Y2 - 0001/01/02/ N1 -RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Humans KW - Intensive Care Units KW - Brazil KW - Patient Safety KW - Checklist KW - Hospital Mortality KW - Clinical Protocols KW - Intensive Care Units/organization & administration/*standards KW - Outcome and Process Assessment, Health Care KW - Quality Improvement/*organization & administration ER - TY - JOUR TI - The "TRAUMA LIFE" initiative: The impact of a multidisciplinary checklist process on outcomes and communication in a Trauma Intensive Care Unit. AU - Joseph K AU - Gupta S AU - Yon J AU - Partida R AU - Cartagena L AU - Kubasiak J AU - Buie V AU - Miller J AU - Wiley D AU - Nagy K AU - Starr F AU - Dennis A AU - Kaminsky M AU - Bokhari F T2 - American journal of surgery AB - BACKGROUND: Checklists have been advocated to improve quality outcomes/communication in the critical care setting, but results have been mixed. A new checklist process, "TRAUMA LIFE", was implemented in our Trauma Intensive Care Unit (TICU) to replace prior checklists. The purpose of this study was to evaluate the impact of the "TRAUMA LIFE" process implementation on quality metrics and on patient/family communication in the TICU. METHODS: "TRAUMA LIFE" was considered maturely implemented by 2016. Multiple quality metrics, including restraint order compliance, were compared between 2013 and 2016 (pre- and post-implementation). Compliance with the "Family Message" (FM), a part of the "TRAUMA LIFE" communication process, was analyzed in 2016. RESULTS: Improvement was seen in CAUTI, VAE, and IUCU; CLABSI rates increased. Restraint order compliance increased significantly. FM delivery compliance was inconsistent; improvement was noted in concordance between update content and FM documented in Electronic Medical Record. CONCLUSION: Implementation of "TRAUMA LIFE" was well integrated into the rounding process and was associated with some improvement in quality metrics and communication. Additional evaluation is required to assess sustainability. DA - 2018/// PY - 2018 VL - 215 IS - 6 SP - 1024 EP - 1028 J2 - Am J Surg LA - eng SN - 1879-1883 (Electronic) UR - https://pubmed.ncbi.nlm.nih.gov/29551472/ AN - 29551472 Y2 - 0006/01/02/ N1 -RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Humans KW - Retrospective Studies KW - Follow-Up Studies KW - Intensive Care Units KW - *Communication KW - *Quality Improvement KW - Critical Care/*standards KW - Checklist/*methods KW - Intensive Care Units/*organization & administration ER - TY - JOUR TI - The Effect of an Electronic Checklist on Critical Care Provider Workload, Errors, and Performance. AU - Thongprayoon C AU - Harrison AM AU - O'Horo JC AU - Berrios RA AU - Pickering BW AU - Herasevich V T2 - Journal of intensive care medicine AB - PURPOSE: The strategy used to improve effective checklist use in intensive care unit (ICU) setting is essential for checklist success. This study aimed to test the hypothesis that an electronic checklist could reduce ICU provider workload, errors, and time to checklist completion, as compared to a paper checklist. METHODS: This was a simulation-based study conducted at an academic tertiary hospital. All participants completed checklists for 6 ICU patients: 3 using an electronic checklist and 3 using an identical paper checklist. In both scenarios, participants had full access to the existing electronic medical record system. The outcomes measured were workload (defined using the National Aeronautics and Space Association task load index [NASA-TLX]), the number of checklist errors, and time to checklist completion. Two independent clinician reviewers, blinded to participant results, served as the reference standard for checklist error calculation. RESULTS: Twenty-one ICU providers participated in this study. This resulted in the generation of 63 simulated electronic checklists and 63 simulated paper checklists. The median NASA-TLX score was 39 for the electronic checklist and 50 for the paper checklist (P = .005). The median number of checklist errors for the electronic checklist was 5, while the median number of checklist errors for the paper checklist was 8 (P = .003). The time to checklist completion was not significantly different between the 2 checklist formats (P = .76). CONCLUSION: The electronic checklist significantly reduced provider workload and errors without any measurable difference in the amount of time required for checklist completion. This demonstrates that electronic checklists are feasible and desirable in the ICU setting. DA - 2016/// PY - 2016 VL - 31 IS - 3 SP - 205 EP - 12 J2 - J Intensive Care Med LA - eng SN - 1525-1489 (Electronic) UR - https://pubmed.ncbi.nlm.nih.gov/25392010/ AN - 25392010 Y2 - 0003/01/02/ N1 -RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Humans KW - Intensive Care Units KW - Critical Care/*organization & administration KW - Outcome and Process Assessment, Health Care KW - Quality Improvement/*organization & administration KW - *Checklist/instrumentation KW - Clinical Competence/*standards KW - Medical Errors/*prevention & control/statistics & numerical data KW - User-Computer Interface KW - Work Simplification KW - Workload/*statistics & numerical data ER - TY - JOUR TI - Optimizing postoperative handover to the intensive care unit at a tertiary centre. AU - Kumar S AU - McKean AR AU - Ramwell A AU - Johnston C AU - Leaver S T2 - British journal of hospital medicine (London, England : 2005) AB - BACKGROUND: Comprehensive handover of patients transferred from operating theatre to the intensive care unit is crucial in ensuring ongoing quality and safety of care. Handover in this setting poses unique challenges, yet few studies have considered or tested approaches to improve the process. A quality improvement project was undertaken to assess and improve the quality of information transfer during the handover of postoperative patients to the general intensive care unit at a tertiary centre. METHODS: This quality improvement project considered all postoperative patients aged 18 years and over, using the plan-do-study-act (PDSA) approach, over a 3-month period in 2015. Baseline audit encompassing intraoperative details (allergies, grade of intubation, estimated blood loss, difficulties and complications) and the postoperative plan (analgesia, thromboprophylaxis, antibiotics and their proposed duration and nutrition) was undertaken to define the extent of the clinical problem. Changes were implemented over two cycles, centred around a novel checklist, and the transfer of information was re-audited after each cycle. RESULTS: Baseline audit (n=30) revealed a need for improvement across all domains. In PDSA cycle 1, a novel checklist was introduced which led to global improvement across all areas with performance exceeding 70% in all but three out of nine domains (n=33). Engaging key stakeholders (PDSA cycle 2) resulted in overall improvement from baseline but decreased performance in just under half of domains in comparison to PDSA cycle 1 (n=31). CONCLUSIONS: Successful implementation of a series of simple interventions resulted in more effective handover of postoperative patients admitted to an intensive care unit. Sustained long-term improvement is a major challenge and can only be achieved with the global engagement of all staff and incorporation of changes into routine clinical practice. DA - 2017/// PY - 2017 VL - 78 IS - 1 SP - 12 EP - 15 J2 - Br J Hosp Med (Lond) LA - eng SN - 1750-8460 (Print) UR - https://pubmed.ncbi.nlm.nih.gov/28067569/ AN - 28067569 Y2 - 0001/01/02/ N1 -RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Humans KW - Intensive Care Units KW - *Checklist KW - *Intensive Care Units KW - *Quality Improvement KW - *Operating Rooms KW - Continuity of Patient Care KW - Patient Handoff/*standards KW - Patient Transfer/standards ER - TY - JOUR TI - High-value care in the surgical intensive care unit: effect on ancillary resources. AU - Ko A AU - Murry JS AU - Hoang DM AU - Harada MY AU - Aquino L AU - Coffey C AU - Sax HC AU - Alban RF T2 - The Journal of surgical research AB - BACKGROUND: Changes in health care policies have influenced transformations in hospital systems to be cost-efficient while maintaining robust outcomes. This is particularly important in intensive care units where significant resources are used to care for critically ill patients. We sought to determine whether high-value care processes (HVCp) implemented in a surgical intensive care unit (SICU) have an impact on commonly used ancillary tests. MATERIALS AND METHODS: An implementation phase using a Lean Six Sigma approach was performed in October 2014 at a 24-bed large academic center SICU with aims to decrease orders of excessive daily laboratory tests and X-rays. The HVCp implemented included use of daily checklists, staff education, and visual reminders emphasizing the importance of appropriate laboratory tests and chest X-rays. Preintervention (July 2014-October 2014) and post-intervention (November 2014-June 2015) phases were compared. RESULTS: Average SICU census, case mix index (4.3 versus 4.4, P = 0.57), all patient refined severity of illness (3.2 versus 3.2, P = 0.91), and SICU mortality (7.1% versus 5.1%, P = 0.18) were similar in both phases. A significant reduction of excessive laboratory tests was evident after the implementation period. Eight hundred sixty-five arterial blood gases/mo were obtained in the preintervention phase compared with 420 arterial blood gases/mo after intervention (P = 0.004), representing a 51.4% reduction. Similar results were obtained with complete blood counts, basic metabolic profiles, coagulation profiles, and chest X-rays (12%, 17.8%, 30.2%, and 20.3% reductions, respectively), a total estimated cost savings of $59,137/mo and prevention of excess phlebotomy of approximately 4 L of blood/mo. CONCLUSIONS: By implementing an HVCp including a checklist, visual reminders, and provider education, we significantly reduced the use of commonly ordered ancillary tests in the SICU without affecting outcomes, resulting in an annual cost savings of $710,000. DA - 2016/// PY - 2016 VL - 202 IS - 2 SP - 455 EP - 60 J2 - J Surg Res LA - eng SN - 1095-8673 (Electronic) UR - https://pubmed.ncbi.nlm.nih.gov/27041599/ AN - 27041599 Y2 - 0005/01/02/ N1 -RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Humans KW - Retrospective Studies KW - Intensive Care Units KW - Checklist KW - Hospital Mortality KW - Intensive Care KW - Outcome and Process Assessment, Health Care KW - California KW - Cost Control KW - Critical Care/economics/methods/*organization & administration KW - Education, Medical, Continuing KW - Education, Nursing, Continuing KW - Health Resources KW - Hospital Costs/statistics & numerical data KW - Intensive Care Units/economics/*organization & administration KW - Internship and Residency KW - Quality Improvement/economics/*organization & administration KW - Unnecessary Procedures/economics/*statistics & numerical data ER - TY - JOUR TI - A multidisciplinary initiative to standardize intensive care to acute care transitions. AU - Halvorson S AU - Wheeler B AU - Willis M AU - Watters J AU - Eastman J AU - O'Donnell R AU - Merkel M T2 - International journal for quality in health care : journal of the International Society for Quality in Health Care AB - QUALITY ISSUE: Transfers from intensive care units to acute care units represent a complex care transition for hospitalized patients. Within our institution, variation in transfer practices resulted in unpredictable processes in which patient safety concerns were raised. INITIAL ASSESSMENT: Key stakeholders were engaged across the institution. Patient safety ('incident') reports and a staff survey identified safety concerns. CHOICE OF A SOLUTION: Using lean methodology, current transfer processes were mapped for the four adult intensive care units and waste was identified. During a summit of key stakeholders an ideal transfer process was conceived and a structured handoff tool (checklist) was developed. A daily management system (DMS) was implemented to monitor adherence. EVALUATION: The primary process outcome was adherence to the standardized workflow. Audits at 4, 8, and 12 months after implementation indicated that the checklist was used for 100% of transfers. Secondary outcomes included the percentage of transfers completed within a pre-specified time window of 120 minutes, provider notification of patient arrival on the acute care unit, and staff survey responses assessing adequacy of transfer communication. LESSONS LEARNED: Prior work has shown that structuring handoffs can improve patient safety, but the novelty of this project was addressing the transfer process in its entirety, across silos of care. Factors leading to the success of this project were the involvement of key stakeholders across the entire institution early in the project development phase, employment of lean methodology, and implementation of tools to guide workflow adherence and track causes of deviation from the workflow. DA - 2016/// PY - 2016 VL - 28 IS - 5 SP - 615 EP - 625 J2 - Int J Qual Health Care LA - eng SN - 1464-3677 (Electronic) UR - https://pubmed.ncbi.nlm.nih.gov/27535085/ AN - 27535085 Y2 - 0010/01/02/ N1 -RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Humans KW - Patient Safety KW - Checklist KW - *Critical Care KW - *Interdisciplinary Communication KW - Organizational Culture KW - Patient Transfer/*standards KW - Total Quality Management ER - TY - JOUR TI - A standard handoff improves cardiac surgical patient transfer: operating room to intensive care unit. AU - Dixon JL AU - Stagg HW AU - Wehbe-Janek H AU - Jo C AU - Culp WC Jr AU - Shake JG T2 - Journal for healthcare quality : official publication of the National Association for Healthcare Quality AB - BACKGROUND: Patient handoffs are high-risk times associated with sentinel events. Effective handoff processes may enhance patient safety and team member communication. This study assesses the impact of a standardized protocol for handoffs from the cardiac surgery operating room to intensive care unit (ICU). METHODS: Using a prospective pre-post study design, a formalized handoff process was developed including critical handoff elements and a standardized handoff procedure, script, and checklist. Data were collected from 60 handoff observations (30 pre and 30 post), evaluating 52 unique parameters, and survey of providers on perspectives of the handoff process. Results were compared by chi-square test, two sample t-test, or nonparametric Mann-Whitney test. Statistical significance was defined as P ≤ .05. RESULTS: Provider's perspectives showed improved satisfaction with the standardized handoff process through improved responses in 19 of 22 survey items (P < .001). Median time until ventilator connection, ICU monitor transfer, first cardiac index, and chest radiograph were reduced after implementation. Completion of handoff process components also improved after implementation for 36 of 47 nontime parameters. CONCLUSIONS: A standard checklist-driven handoff process can dramatically improve key data transmission and reduce time of critical patient care steps during the high-risk period of patient handoff in a cardiac surgical ICU. DA - 2015/// PY - 2015 VL - 37 IS - 1 SP - 22 EP - 32 J2 - J Healthc Qual LA - eng SN - 1945-1474 (Electronic) UR - https://pubmed.ncbi.nlm.nih.gov/26042374/ AN - 26042374 Y2 - 0001/01/02/ N1 -RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Humans KW - Prospective Studies KW - Intensive Care Units KW - Patient Safety KW - Checklist KW - Surveys and Questionnaires KW - Intensive Care Units/*organization & administration KW - *Cardiac Surgical Procedures KW - Information Dissemination KW - Operating Rooms/*organization & administration KW - Patient Handoff/*organization & administration/*standards KW - Patient Transfer/*organization & administration/*standards KW - Personnel, Hospital ER - TY - JOUR TI - Incidence of ventilator-associated pneumonia in Australasian intensive care units: use of a consensus-developed clinical surveillance checklist in a multisite prospective audit. AU - Elliott D AU - Elliott R AU - Burrell A AU - Harrigan P AU - Murgo M AU - Rolls K AU - Sibbritt D T2 - BMJ open AB - OBJECTIVES: With disagreements on diagnostic criteria for ventilator-associated pneumonia (VAP) hampering efforts to monitor incidence and implement preventative strategies, the study objectives were to develop a checklist for clinical surveillance of VAP, and conduct an audit in Australian/New Zealand intensive care units (ICUs) using the checklist. SETTING: Online survey software was used for checklist development. The prospective audit using the checklist was conducted in 10 ICUs in Australia and New Zealand. PARTICIPANTS: Checklist development was conducted with members of a bi-national professional society for critical care physicians using a modified Delphi technique and survey. A 30-day audit of adult patients mechanically ventilated for >72 h. PRIMARY AND SECONDARY OUTCOME MEASURES: Presence of items on the screening checklist; physician diagnosis of VAP, clinical characteristics, investigations, treatments and patient outcome. RESULTS: A VAP checklist was developed with five items: decreasing gas exchange, sputum changes, chest X-ray infiltrates, inflammatory response, microbial growth. Of the 169 participants, 17% (n=29) demonstrated characteristics of VAP using the checklist. A similar proportion had an independent physician diagnosis (n=30), but in a different patient subset (only 17% of cases were identified by both methods). The VAP rate per 1000 mechanical ventilator days for the checklist and clinician diagnosis was 25.9 and 26.7, respectively. The item 'inflammatory response' was most associated with the first episode of physician-diagnosed VAP. CONCLUSIONS: VAP rates using the checklist and physician diagnosis were similar to ranges reported internationally and in Australia. Of note, different patients were identified with VAP by the checklist and physicians. While the checklist items may assist in identifying patients at risk of developing VAP, and demonstrates synergy with the recently developed Centers for Disease Control (CDC) guidelines, decision-making processes by physicians when diagnosing VAP requires further exploration. DA - 2015/// PY - 2015 VL - 5 IS - 10 SP - e008924 J2 - BMJ Open LA - eng SN - 2044-6055 (Electronic) UR - https://pubmed.ncbi.nlm.nih.gov/26515685/ AN - 26515685 Y2 - 0010/01/02/ N1 -RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Humans KW - Adult KW - Female KW - Male KW - Incidence KW - Aged KW - Middle Aged KW - Prospective Studies KW - Inflammation KW - *Checklist KW - *Intensive Care Units KW - Ventilators, Mechanical KW - *Critical Care KW - Consensus KW - Australia/epidemiology KW - Mass Screening/*methods KW - Medical Audit KW - New Zealand/epidemiology KW - Physicians KW - Pneumonia, Ventilator-Associated/*diagnosis/epidemiology ER - TY - JOUR TI - Intelligent dynamic clinical checklists improved checklist compliance in the intensive care unit. AU - De Bie AJR AU - Nan S AU - Vermeulen LRE AU - Van Gorp PME AU - Bouwman RA AU - Bindels AJGH AU - Korsten HHM T2 - British journal of anaesthesia AB - BACKGROUND: Checklists can reduce medical errors. However, the effectiveness of checklists is hampered by lack of acceptance and compliance. Recently, a new type of checklist with dynamic properties has been created to provide more specific checklist items for each individual patient. Our purpose in this simulation-based study was to investigate a newly developed intelligent dynamic clinical checklist (DCC) for the intensive care unit (ICU) ward round. METHODS: Eligible clinicians were invited to participate as volunteers. Highest achievable scores were established for six typical ICU scenarios to determine which items must be checked. The participants compared the DCC with the local standard of care. The primary outcomes were the caregiver satisfaction score and the percentages of checked items overall and of critical items requiring a direct intervention. RESULTS: In total, 20 participants were included, who performed 116 scenarios. The median percentage of checked items was 100.0% with the DCC and 73.6% for the scenarios completed with local standard of care ( P <0.001). Critical items remained unchecked in 23.1% of the scenarios performed with local standard of care and 0.0% of the scenarios where the DCC was available ( P <0.001). The mean satisfaction score of the DCC was 4.13 out of 5. CONCLUSIONS: This simulation study indicates that an intelligent DCC significantly increases compliance with best practice by reducing the percentage of unchecked items during ICU ward rounds, while the user satisfaction rate remains high. Real-life clinical research is required to evaluate this new type of checklist further. DA - 2017/// PY - 2017 VL - 119 IS - 2 SP - 231 EP - 238 J2 - Br J Anaesth LA - eng SN - 1471-6771 (Electronic) UR - https://pubmed.ncbi.nlm.nih.gov/28854530/ AN - 28854530 Y2 - 0008/01/02/ N1 -RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Humans KW - Adult KW - Female KW - Male KW - Aged KW - Middle Aged KW - Prospective Studies KW - Intensive Care Units KW - *Checklist KW - *Intensive Care Units KW - Cross-Over Studies KW - Intelligence KW - Personal Satisfaction ER - TY - JOUR TI - The incorporation of focused history in checklist for early recognition and treatment of acute illness and injury. AU - Jayaprakash N AU - Ali R AU - Kashyap R AU - Bennett C AU - Kogan A AU - Gajic O T2 - BMC emergency medicine AB - BACKGROUND: Diagnostic error and delay are critical impediments to the safety of critically ill patients. Checklist for early recognition and treatment of acute illness and injury (CERTAIN) has been developed as a tool that facilitates timely and error-free evaluation of critically ill patients. While the focused history is an essential part of the CERTAIN framework, it is not clear how best to choreograph this step in the process of evaluation and treatment of the acutely decompensating patient. METHODS: An un-blinded crossover clinical simulation study was designed in which volunteer critical care clinicians (fellows and attendings) were randomly assigned to start with either obtaining a focused history choreographed in series (after) or in parallel to the primary survey. A focused history was obtained using the standardized SAMPLE model that is incorporated into American College of Trauma Life Support (ATLS) and Pediatric Advanced Life Support (PALS). Clinicians were asked to assess six acutely decompensating patients using pre - determined clinical scenarios (three in series choreography, three in parallel). Once the initial choreography was completed the clinician would crossover to the alternative choreography. The primary outcome was the cognitive burden assessed through the NASA task load index. Secondary outcome was time to completion of a focused history. RESULTS: A total of 84 simulated cases (42 in parallel, 42 in series) were tested on 14 clinicians. Both the overall cognitive load and time to completion improved with each successive practice scenario, however no difference was observed between the series versus parallel choreographies. The median (IQR) overall NASA TLX task load index for series was 39 (17 - 58) and for parallel 43 (27 - 52), p = 0.57. The median (IQR) time to completion of the tasks in series was 125 (112 - 158) seconds and in parallel 122 (108 - 158) seconds, p = 0.92. CONCLUSION: In this clinical simulation study assessing the incorporation of a focused history into the primary survey of a non-trauma critically ill patient, there was no difference in cognitive burden or time to task completion when using series choreography (after the exam) compared to parallel choreography (concurrent with the primary survey physical exam). However, with repetition of the task both overall task load and time to completion improved in each of the choreographies. DA - 2016/// PY - 2016 VL - 16 IS - 1 SP - 35 J2 - BMC Emerg Med LA - eng SN - 1471-227X (Electronic) UR - https://pubmed.ncbi.nlm.nih.gov/27578062/ AN - 27578062 Y2 - 0008/01/02/ N1 -RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Humans KW - Female KW - Male KW - Cognition KW - Simulation Training KW - Pilot Projects KW - Checklist/*methods KW - Cross-Over Studies KW - Clinical Competence KW - Critical Care/*methods KW - Medical History Taking/*methods ER - TY - JOUR TI - Using a Post-Intubation Checklist and Time Out to Expedite Mechanical Ventilation Monitoring: Observational Study of a Quality Improvement Intervention. AU - McConnell RA AU - Kerlin MP AU - Schweickert WD AU - Ahmad F AU - Patel MS AU - Fuchs BD T2 - Respiratory care AB - BACKGROUND: Delayed mechanical ventilation monitoring may impede recognition of life-threatening acidemia. Coordination of multidisciplinary processes can be improved by using a checklist and time-out procedure. The study objective was to evaluate process-related outcomes after implementation of a post-intubation checklist and time out. METHODS: An observational study of a 24-bed medical ICU in Philadelphia, Pennsylvania, was conducted from January to December 2011. A random sample of mechanically ventilated adults was selected from the pre-intervention (n = 80) and post-intervention (n = 144) periods. The primary outcome was the proportion of subjects with an arterial blood gas (ABG) result within 60 min of mechanical ventilation initiation. Secondary outcomes included rates of respiratory acidosis, moderate-severe acidemia (pH <7.25), checklist initiation, and project sustainability. Chi-square analysis was used to evaluate differences in outcomes between time periods. RESULTS: After the intervention, the proportion of subjects with an ABG result within 60 min increased (56% vs 37%, P = .01), and time to ABG result improved (58 min vs 79 min, P = .004). Adjusting for illness severity, the proportion with an ABG result within 60 min remained significantly higher in the post-intervention period (odds ratio 2.42, 95% CI 1.25-4.68, P = .009). Checklist adherence was higher with ICU intubations than for intubations performed outside the ICU (71% vs 27% checklist initiation rate, P < .001). Transfer from referring institutions (23% checklist initiation rate, P = .006) negatively impacted checklist use. Implementation challenges included frequent stakeholder turnover, undefined process ownership, and lack of real-time performance feedback. CONCLUSIONS: A post-intubation checklist and time out improved the timeliness of mechanical ventilation monitoring through more rapid assessment of arterial blood gases. Implementing this peri-intubation procedure may reduce the risks associated with transitioning to full mechanical ventilatory support. Optimal implementation necessitates strategies to surmount organizational and behavioral barriers to change. DA - 2016/// PY - 2016 VL - 61 IS - 7 SP - 902 EP - 12 J2 - Respir Care LA - eng SN - 1943-3654 (Electronic) UR - https://pubmed.ncbi.nlm.nih.gov/26932381/ AN - 26932381 Y2 - 0007/01/02/ N1 -RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Humans KW - Female KW - Male KW - Aged KW - Middle Aged KW - Intensive Care Units KW - Respiration, Artificial KW - Ventilators, Mechanical KW - *Quality Improvement KW - Checklist/*methods KW - Outcome and Process Assessment, Health Care KW - Blood Gas Analysis KW - Critical Care/methods/*standards KW - Intubation/adverse effects/methods/*standards KW - Monitoring, Physiologic/methods/standards KW - Philadelphia KW - Respiration, Artificial/adverse effects/methods/*standards KW - Time Factors KW - Ventilator-Induced Lung Injury/etiology/prevention & control ER - TY - JOUR TI - The effectiveness of an intensive care quick reference checklist manual--a randomized simulation-based trial. AU - Just KS AU - Hubrich S AU - Schmidtke D AU - Scheifes A AU - Gerbershagen MU AU - Wappler F AU - Grensemann J T2 - Journal of critical care AB - PURPOSE: We aimed to test the effectiveness of checklists for emergency procedures on medical staff performance in intensive care crises. MATERIALS AND METHODS: This is a prospective single-center randomized trial in a high-fidelity simulation center modeling an intensive care unit (ICU) in a tertiary care hospital in Germany. Teams consisted of 1 ICU resident and 2 ICU nurses (in total, n = 48). All completed 4 crisis scenarios, in which they were randomized to use checklists or to perform without any aid. In 2 of the scenarios, checklists could be used immediately (type 1 scenarios); and for the remaining, some further steps, for example, confirming diagnosis, were required first (type 2 scenarios). Outcome measurements were number of predefined items and time to completion of more than 50% and more than 75% of steps, respectively. RESULTS: When using checklists, participants initiated items faster and more completely according to appropriate treatment guidelines (9 vs 7 items with and without checklists, P < .05). Benefit of checklists was better in type 2 scenarios than in type 1 scenarios (2 vs 1 additional item, P < .05). In type 2 scenarios, time to complete 50% and 75% of items was faster with the use of checklists (P < .005). CONCLUSIONS: Use of checklists in ICU crises has a benefit on the completion of critical treatment steps. Within the type 2 scenarios, items were fulfilled faster with checklists. The implementation of checklists for intensive care crises is a promising approach that may improve patients' care. DA - 2015/// PY - 2015 VL - 30 IS - 2 SP - 255 EP - 60 J2 - J Crit Care LA - eng SN - 1557-8615 (Electronic) UR - https://pubmed.ncbi.nlm.nih.gov/25457116/ AN - 25457116 Y2 - 0004/01/02/ N1 -RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Humans KW - Female KW - Male KW - Aged KW - Prospective Studies KW - Intensive Care Units KW - *Checklist KW - Critical Care/*organization & administration KW - Quality Improvement/*organization & administration KW - *Outcome and Process Assessment, Health Care KW - Germany ER - TY - JOUR TI - Picking the Right Tool for the Job: A Reliability Study of 4 Assessment Tools for Central Venous Catheter Insertion. AU - Lord JA AU - Zuege DJ AU - Mackay MP AU - des Ordons AR AU - Lockyer J T2 - Journal of graduate medical education AB - BACKGROUND: Determining procedural competence requires psychometrically sound assessment tools. A variety of instruments are available to determine procedural performance for central venous catheter (CVC) insertion, but it is not clear which ones should be used in the context of competency-based medical education. OBJECTIVE: We compared several commonly used instruments to determine which should be preferentially used to assess competence in CVC insertion. METHODS: Junior residents completing their first intensive care unit rotation between July 31, 2006, and March 9, 2007, were video-recorded performing CVC insertion on task trainer mannequins. Between June 1, 2016, and September 30, 2016, 3 experienced raters judged procedural competence on the historical video recordings of resident performance using 4 separate tools, including an itemized checklist, Objective Structured Assessment of Technical Skills (OSATS), a critical error assessment tool, and the Ottawa Surgical Competency Operating Room Evaluation (O-SCORE). Generalizability theory (G-theory) was used to compare the performance characteristics among the tools. A decision study predicted the optimal testing environment using the tools. RESULTS: At the time of the original recording, 127 residents rotated through intensive care units at the University of Calgary, Alberta, Canada. Seventy-seven of them (61%) met inclusion criteria, and 55 of those residents (71%) agreed to participate. Results from the generalizability study (G-study) demonstrated that scores from O-SCORE and OSATS were the most dependable. Dependability could be maintained for O-SCORE and OSATS with 2 raters. CONCLUSIONS: Our results suggest that global rating scales, such as the OSATS or the O-SCORE tools, should be preferentially utilized for assessment of competence in CVC insertion. DA - 2019/// PY - 2019 VL - 11 IS - 4 SP - 422 EP - 429 J2 - J Grad Med Educ LA - eng SN - 1949-8357 (Electronic) UR - https://pubmed.ncbi.nlm.nih.gov/31440337/ AN - 31440337 Y2 - 0008/01/02/ N1 -RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Humans KW - Female KW - Male KW - Critical Care KW - Checklist KW - *Educational Measurement KW - *Internship and Residency KW - *Manikins KW - *Reproducibility of Results KW - Alberta KW - Catheterization, Central Venous/*instrumentation KW - Central Venous Catheters/*standards KW - Competency-Based Education/*standards KW - Education, Medical, Graduate ER - TY - JOUR TI - Developing content for a process-of-care checklist for use in intensive care units: a dual-method approach to establishing construct validity. AU - Conroy KM AU - Elliott D AU - Burrell AR T2 - BMC health services research AB - BACKGROUND: In the intensive care unit (ICU), checklists can be used to support the delivery of quality and consistent clinical care. While studies have reported important benefits for clinical checklists in this context, lack of formal validity testing in the literature prompted the study aim; to develop relevant 'process-of-care' checklist statements, using rigorously applied and reported methods that were clear, concise and reflective of the current evidence base. These statements will be sufficiently instructive for use by physicians during ICU clinical rounds. METHODS: A dual-method approach was utilized; semi-structured interviews with local clinicians; and rounds of surveys to an expert Delphi panel. The interviews helped determine checklist item inclusion/exclusion prior to the first round Delphi survey. The panel for the modified-Delphi technique consisted of local intensivists and a state-wide ICU quality committee. Minimum standards for consensus agreement were set prior to the distribution of questionnaires, and rounds of surveys continued until consensus was achieved. RESULTS: A number of important issues such as overlap with other initiatives were identified in interviews with clinicians and integrated into the Delphi questionnaire, but no additional checklist items were suggested, demonstrating adequate checklist coverage sourced from the literature. These items were verified by local clinicians as being relevant to ICU and important elements of care that required checking during ward rounds. Two rounds of Delphi surveys were required to reach consensus on nine checklist statements: nutrition, pain management, sedation, deep vein thrombosis and stress ulcer prevention, head-of-bed elevation, blood glucose levels, readiness to extubate, and medications. CONCLUSIONS: Statements were developed as the most clear, concise, evidence-informed and instructive statements for use during clinical rounds in an ICU. Initial evidence in support of the checklist's construct validity was established prior to further prospective evaluation in the same ICU. DA - 2013/// PY - 2013 VL - 13 SP - 380 J2 - BMC Health Serv Res LA - eng SN - 1472-6963 (Electronic) UR - https://pubmed.ncbi.nlm.nih.gov/24088360/ AN - 24088360 Y2 - 0010/01/02/ N1 -RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Humans KW - Intensive Care Units KW - Intensive Care Units/*organization & administration/standards KW - Surveys and Questionnaires KW - Critical Care/methods/standards KW - Reproducibility of Results KW - Delphi Technique KW - Checklist/*methods/standards KW - Interviews as Topic ER - TY - JOUR TI - Real-time random safety audits: A transforming tool adapted to new times. AU - Bodí M AU - Oliva I AU - Martín MC AU - Sirgo G T2 - Medicina intensiva AB - Real-time random safety audits constitute a tool designed to transfer knowledge from the sources of scientific evidence to the patient bedside. It has proven useful in critically ill patients, improving safety in the process of critical patient care, turning unsafe situations into safe ones in daily practice, and ensuring adherence to scientific evidence. In parallel, the design and methodology involved affords process indicators that will make it possible to know how we provide care for our patients, evolution over time (with regular feedback for professionals), the impact of our interventions, and benchmarking. DA - 2017/// PY - 2017 VL - 41 IS - 6 SP - 368 EP - 376 J2 - Med Intensiva LA - ["eng", "spa"] SN - 1578-6749 (Electronic) UR - https://pubmed.ncbi.nlm.nih.gov/27776937/ AN - 27776937 Y2 - 0008/01/02/ N1 -RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Humans KW - Intensive Care Units KW - Checklist KW - Critical Care/*standards KW - *Patient Safety KW - Medical Errors/prevention & control KW - *Medical Audit KW - Random Allocation ER - TY - JOUR TI - A cluster randomized trial for the implementation of an antibiotic checklist based on validated quality indicators: the AB-checklist. AU - van Daalen FV AU - Prins JM AU - Opmeer BC AU - Boermeester MA AU - Visser CE AU - van Hest RM AU - Hulscher ME AU - Geerlings SE T2 - BMC infectious diseases AB - BACKGROUND: Recently we developed and validated generic quality indicators that define 'appropriate antibiotic use' in hospitalized adults treated for a (suspected) bacterial infection. Previous studies have shown that with appropriate antibiotic use a reduction of 13% of length of hospital stay can be achieved. Our main objective in this project is to provide hospitals with an antibiotic checklist based on these quality indicators, and to evaluate the introduction of this checklist in terms of (cost-) effectiveness. METHODS/DESIGN: The checklist applies to hospitalized adults with a suspected bacterial infection for whom antibiotic therapy is initiated, at first via the intravenous route. A stepped wedge study design will be used, comparing outcomes before and after introduction of the checklist in nine hospitals in the Netherlands. At least 810 patients will be included in both the control and the intervention group. The primary endpoint is length of hospital stay. Secondary endpoints are appropriate antibiotic use measured by the quality indicators, admission to and duration of intensive care unit stay, readmission within 30 days, mortality, total antibiotic use, and costs associated with implementation and hospital stay. Differences in numerical endpoints between the two periods will be evaluated with mixed linear models; for dichotomous outcomes generalized estimating equation models will be used. A process evaluation will be performed to evaluate the professionals' compliance with use of the checklist. The key question for the economic evaluation is whether the benefits of the checklist, which include reduced antibiotic use, reduced length of stay and associated costs, justify the costs associated with implementation activities as well as daily use of the checklist. DISCUSSION: If (cost-) effective, the AB-checklist will provide physicians with a tool to support appropriate antibiotic use in adult hospitalized patients who start with intravenous antibiotics. TRIAL REGISTRATION: Dutch trial registry: NTR4872. DA - 2015/// PY - 2015 VL - 15 SP - 134 J2 - BMC Infect Dis LA - eng SN - 1471-2334 (Electronic) UR - https://pubmed.ncbi.nlm.nih.gov/25888180/ AN - 25888180 Y2 - 0003/01/02/ N1 -RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Humans KW - Adult KW - Female KW - Cost-Benefit Analysis KW - *Checklist/economics/methods/standards KW - *Quality Indicators, Health Care/standards KW - Anti-Bacterial Agents KW - Anti-Bacterial Agents/economics/*therapeutic use KW - Bacterial Infections/*drug therapy/economics/epidemiology KW - Health Plan Implementation KW - Intensive Care Units/economics/statistics & numerical data KW - Length of Stay/economics/statistics & numerical data KW - Netherlands/epidemiology KW - Patient Care Planning/economics/organization & administration/standards KW - Quality Indicators, Health Care KW - Registries/statistics & numerical data KW - Research Design ER - TY - JOUR TI - A Multicenter Randomized Trial of a Checklist for Endotracheal Intubation of Critically Ill Adults. AU - Janz DR AU - Semler MW AU - Joffe AM AU - Casey JD AU - Lentz RJ AU - deBoisblanc BP AU - Khan YA AU - Santanilla JI AU - Bentov I AU - Rice TW T2 - Chest AB - BACKGROUND: Hypoxemia and hypotension are common complications during endotracheal intubation of critically ill adults. Verbal performance of a written, preintubation checklist may prevent these complications. We compared a written, verbally performed, preintubation checklist with usual care regarding lowest arterial oxygen saturation or lowest systolic BP experienced by critically ill adults undergoing endotracheal intubation. METHODS: A multicenter trial in which 262 adults undergoing endotracheal intubation were randomized to a written, verbally performed, preintubation checklist (checklist) or no preintubation checklist (usual care). The coprimary outcomes were lowest arterial oxygen saturation and lowest systolic BP between the time of procedural medication administration and 2 min after endotracheal intubation. RESULTS: The median lowest arterial oxygen saturation was 92% (interquartile range [IQR], 79-98) in the checklist group vs 93% (IQR, 84-100) with usual care (P = .34). The median lowest systolic BP was 112 mm Hg (IQR, 94-133) in the checklist group vs 108 mm Hg (IQR, 90-132) in the usual care group (P = .61). There was no difference between the checklist and usual care in procedure duration (120 vs 118 s; P = .49), number of laryngoscopy attempts (one vs one attempt; P = .42), or severe life-threatening procedural complications (40.8% vs 32.6%; P = .20). CONCLUSIONS: The verbal performance of a written, preprocedure checklist does not increase the lowest arterial oxygen saturation or lowest systolic BP during endotracheal intubation of critically ill adults compared with usual care. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT02497729; URL: www.clinicaltrials.gov. DA - 2018/// PY - 2018 VL - 153 IS - 4 SP - 816 EP - 824 J2 - Chest LA - eng SN - 1931-3543 (Electronic) UR - https://pubmed.ncbi.nlm.nih.gov/28917549/ AN - 28917549 Y2 - 0004/01/02/ N1 -RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Humans KW - Female KW - Male KW - Treatment Outcome KW - Middle Aged KW - Critical Illness KW - Critical Illness/*therapy KW - *Checklist KW - Airway Management/methods KW - Critical Care/methods KW - Intubation, Intratracheal KW - Intubation, Intratracheal/*methods KW - Laryngoscopy/methods KW - Oxygen/blood KW - Partial Pressure KW - Patient Positioning ER - TY - JOUR TI - Implementation of an electronic checklist in the ICU: Association with improved outcomes. AU - Duclos G AU - Zieleskiewicz L AU - Antonini F AU - Mokart D AU - Paone V AU - Po MH AU - Vigne C AU - Hammad E AU - Potié F AU - Martin C AU - Medam S AU - Leone M T2 - Anaesthesia, critical care & pain medicine AB - OBJECTIVE: To assess the impact of an electronic checklist during the morning rounds on ventilator-associated pneumonia (VAP) in the intensive care unit (ICU). PATIENTS AND METHODS: We conducted a retrospective, before/after study in a single ICU of a university hospital. A systematic electronic checklist focusing on guidelines adherence was introduced in January 2012. From January 2008 to June 2014, we screened patients with ICU stay durations of at least 48hours. Propensity score-matched analysis with conditional logistic regression was used to compare the rate of VAP and number of days free of invasive devices before and after implementation of the electronic checklist. RESULTS: We analysed 1711 patients (before group, n=761; after group, n=950). The rates of VAP were 21% and 11% in the before and after groups, respectively (p<0.001). In propensity-score matched analysis (n=742 in each group), VAP occurred in 151 patients (21%) during the before period compared with 72 patients (10%) during the after period (odds ratio [OR]=0.38; 95% confidence interval [CI]=0.27-0.53). The after group showed increases in ICU-free days (OR=1.05; 95% CI=1.04-1.07) and mechanical ventilation-free days (OR=1.03; 95% CI=1.01-1.04). CONCLUSION: In this matched before/after study, implementation of an electronic checklist was associated with positive effects on patient outcomes, especially on VAP. Further prospective studies are needed to confirm these observations. DA - 2018/// PY - 2018 VL - 37 IS - 1 SP - 25 EP - 33 J2 - Anaesth Crit Care Pain Med LA - eng SN - 2352-5568 (Electronic) UR - https://pubmed.ncbi.nlm.nih.gov/28705759/ AN - 28705759 Y2 - 0002/01/02/ N1 -RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Humans KW - Adult KW - Female KW - Male KW - Treatment Outcome KW - Retrospective Studies KW - Aged KW - Middle Aged KW - *Checklist KW - Respiration, Artificial/statistics & numerical data KW - Critical Care/*methods KW - Electronics KW - Guideline Adherence KW - Hospitals, University KW - Pneumonia, Ventilator-Associated/diagnosis/epidemiology/*therapy KW - Propensity Score ER - TY - JOUR TI - A patient-centred care and engagement program in intensive care reduces adverse events and improves patient and care partner satisfaction. AU - Manias E T2 - Australian critical care : official journal of the Confederation of Australian Critical Care Nurses DA - 2019/// PY - 2019 VL - 32 IS - 2 SP - 179 EP - 181 J2 - Aust Crit Care LA - eng SN - 1036-7314 (Print) UR - https://pubmed.ncbi.nlm.nih.gov/30471940/ AN - 30471940 Y2 - 0003/01/02/ N1 -RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Humans KW - Adult KW - Female KW - Male KW - Aged KW - Middle Aged KW - Communication KW - Patient Safety KW - Quality Improvement KW - Checklist KW - Intensive Care Units/*organization & administration KW - Patient Care Team/*organization & administration KW - Outcome and Process Assessment, Health Care KW - *Patient Satisfaction KW - *Personal Satisfaction KW - Caregivers/*psychology KW - Inservice Training/organization & administration KW - Patient Care Planning/organization & administration KW - Patient Participation/*methods KW - Patient-Centered Care/*organization & administration ER - TY - JOUR TI - Development and Pilot of a Checklist for Management of Acute Liver Failure in the Intensive Care Unit. AU - Fix OK AU - Liou I AU - Karvellas CJ AU - Ganger DR AU - Forde KA AU - Subramanian RM AU - Boylan A AU - Hanje J AU - Stravitz RT AU - Lee WM T2 - PloS one AB - INTRODUCTION: Acute liver failure (ALF) is an ideal condition for use of a checklist. Our aims were to develop a checklist for the management of ALF in the intensive care unit (ICU) and assess the usability of the checklist among multiple providers. METHODS: The initial checklist was developed from published guidelines and expert opinion. The checklist underwent pilot testing at 11 academic liver transplant centers in the US and Canada. An anonymous, written survey was used to assess the usability and quality of the checklist. Written comments were used to improve the checklist following the pilot testing period. RESULTS: We received 81 surveys involving the management of 116 patients during the pilot testing period. The overall quality of the checklist was judged to be above average to excellent by 94% of users. On a 5-point Likert scale, the majority of survey respondents agreed or agreed strongly with the following checklist characteristics: the checklist was easy to read (99% agreed/agreed strongly), easy to use (97%), items are categorized logically (98%), time to complete the checklist did not interfere with delivery of appropriate and safe patient care (94%) and was not excessively burdensome (92%), the checklist allowed the user the freedom to use his or her clinical judgment (80%), it is a useful tool in the management of acute liver failure (98%). Web-based and mobile apps were developed for use of the checklist at the point of care. CONCLUSION: The checklist for the management of ALF in the ICU was shown in this pilot study to be easy to use, helpful and accepted by a wide variety of practitioners at multiple sites in the US and Canada. DA - 2016/// PY - 2016 VL - 11 IS - 5 SP - e0155500 J2 - PLoS One LA - eng SN - 1932-6203 (Electronic) UR - https://pubmed.ncbi.nlm.nih.gov/27176033/ AN - 27176033 N1 -RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Humans KW - Intensive Care Units KW - Intensive Care Units/*standards KW - Checklist/*standards KW - Pilot Projects KW - Health Care Surveys KW - Liver KW - Liver Failure, Acute KW - Liver Failure, Acute/*therapy ER - TY - JOUR TI - Audits in real time for safety in critical care: definition and pilot study. AU - Sirgo Rodríguez G AU - Olona Cabases M AU - Martin Delgado MC AU - Esteban Reboll F AU - Pobo Peris A AU - Bodí Saera M T2 - Medicina intensiva AB - Adverse events significantly impact upon mortality rates and healthcare costs. PURPOSE: To design a checklist of safety measures based on relevant scientific literature, apply random checklist measures to critically ill patients in real time (safety audits), and determine its utility and feasibility. METHODS: A list of safety measures based on scientific literature was drawn up by investigators. Subsequently, a group of selected experts evaluated these measures using the Delphi methodology. Audits were carried out on 14 days over a period of one month. Each day, 50% of the measures were randomly selected and measured in 50% of the randomized patients. Utility was assessed by measuring the changes in clinical performance after audits, using the variable improvement proportion related to audits. Feasibility was determined by the successful completion of auditing on each of the days on which audits were attempted. RESULTS: The final verified checklist comprised 37 measures distributed into 10 blocks. The improvement proportion related to audits was reported in 83.78% of the measures. This proportion was over 25% in the following measures: assessment of the alveolar pressure limit, checking of mechanical ventilation alarms, checking of monitor alarms, correct prescription of the daily treatment orders, daily evaluation of the need for catheters, enteral nutrition monitoring, assessment of semi-recumbent position, and checking that patient clinical information is properly organized in the clinical history. Feasibility: rounds were completed on the 14 proposed days. CONCLUSIONS: Audits in real time are a useful and feasible tool for modifying clinical actions and minimizing errors. DA - 2014/// PY - 2014 VL - 38 IS - 8 SP - 473 EP - 82 J2 - Med Intensiva LA - eng SN - 1578-6749 (Electronic) UR - https://pubmed.ncbi.nlm.nih.gov/24508337/ AN - 24508337 Y2 - 0011/01/02/ N1 -RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Humans KW - Diagnosis-Related Groups KW - Feasibility Studies KW - Checklist KW - Pilot Projects KW - Delphi Technique KW - *Patient Safety KW - *Medical Audit KW - Patient Positioning KW - Catheterization KW - Clinical Alarms KW - Computer Systems KW - Critical Care Nursing/standards KW - Critical Care/*methods/standards KW - Enteral Nutrition KW - Monitoring, Physiologic/instrumentation/methods KW - Pain Management KW - Patient Care/*methods/standards ER - TY - JOUR TI - Comparative evaluation of the content and structure of communication using two handoff tools: implications for patient safety. AU - Abraham J AU - Kannampallil TG AU - Almoosa KF AU - Patel B AU - Patel VL T2 - Journal of critical care AB - PURPOSE: Handoffs vary in their structure and content, raising concerns regarding standardization. We conducted a comparative evaluation of the nature and patterns of communication on 2 functionally similar but conceptually different handoff tools: Subjective, Objective, Assessment and Plan, based on a patient problem-based format, and Handoff Intervention Tool (HAND-IT), based on a body system-based format. METHOD: A nonrandomized pre-post prospective intervention study supported by audio recordings and observations of 82 resident handoffs was conducted in a medical intensive care unit. Qualitative analysis was complemented with exploratory sequential pattern analysis techniques to capture the characteristics and types of communication events (CEs) and breakdowns. RESULTS: Use of HAND-IT led to fewer communication breakdowns (F1,80 = 45.66: P < .0001), greater number of CEs (t40 = 4.56; P < .001), with more ideal CEs than Subjective, Objective, Assessment and Plan (t40 = 9.27; P < .001). In addition, the use of HAND-IT was characterized by more request-response CE transitions. CONCLUSION: The HAND-IT's body system-based structure afforded physicians the ability to better organize and comprehend patient information and led to an interactive and streamlined communication, with limited external input. Our results also emphasize the importance of information organization using a medical knowledge hierarchical format for fostering effective communication. DA - 2014/// PY - 2014 VL - 29 IS - 2 SP - 311.e1 EP - 7 J2 - J Crit Care LA - eng SN - 1557-8615 (Electronic) UR - https://pubmed.ncbi.nlm.nih.gov/24360818/ AN - 24360818 Y2 - 0004/01/02/ N1 -RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Humans KW - Prospective Studies KW - *Checklist KW - *Communication KW - *Intensive Care Units KW - *Patient Safety KW - *Patient Handoff/organization & administration/standards KW - Controlled Before-After Studies KW - Problem-Based Learning KW - Qualitative Research ER - TY - JOUR TI - Checklist for Early Recognition and Treatment of Acute Illness (CERTAIN): evolution of a content management system for point-of-care clinical decision support. AU - Barwise A AU - Garcia-Arguello L AU - Dong Y AU - Hulyalkar M AU - Vukoja M AU - Schultz MJ AU - Adhikari NK AU - Bonneton B AU - Kilickaya O AU - Kashyap R AU - Gajic O AU - Schmickl CN T2 - BMC medical informatics and decision making AB - BACKGROUND: The Checklist for Early Recognition and Treatment of Acute Illness (CERTAIN) is an international collaborative project with the overall objective of standardizing the approach to the evaluation and treatment of critically ill patients world-wide, in accordance with best-practice principles. One of CERTAIN's key features is clinical decision support providing point-of-care information about common acute illness syndromes, procedures, and medications in an index card format. METHODS: This paper describes 1) the process of developing and validating the content for point-of-care decision support, and 2) the content management system that facilitates frequent peer-review and allows rapid updates of content across different platforms (CERTAIN software, mobile apps, pdf-booklet) and different languages. RESULTS: Content was created based on survey results of acute care providers and validated using an open peer-review process. Over a 3 year period, CERTAIN content expanded to include 67 syndrome cards, 30 procedure cards, and 117 medication cards. 127 (59 %) cards have been peer-reviewed so far. Initially MS Word® and Dropbox® were used to create, store, and share content for peer-review. Recently Google Docs® was used to make the peer-review process more efficient. However, neither of these approaches met our security requirements nor has the capacity to instantly update the different CERTAIN platforms. CONCLUSION: Although we were able to successfully develop and validate a large inventory of clinical decision support cards in a short period of time, commercially available software solutions for content management are suboptimal. Novel custom solutions are necessary for efficient global point of care content system management. DA - 2016/// PY - 2016 VL - 16 IS - 1 SP - 127 J2 - BMC Med Inform Decis Mak LA - eng SN - 1472-6947 (Electronic) UR - https://pubmed.ncbi.nlm.nih.gov/27716243/ AN - 27716243 Y2 - 0010/01/02/ N1 -RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Humans KW - *Checklist KW - Critical Care/*methods KW - *Decision Support Systems, Clinical KW - *Early Diagnosis KW - *Point-of-Care Systems KW - Acute Disease/*therapy KW - Point-of-Care Systems ER - TY - JOUR TI - Prompting physicians to address a daily checklist for antibiotics: do we need a co-pilot in the ICU? AU - Weiss CH AU - Wunderink RG T2 - Current opinion in critical care AB - PURPOSE OF REVIEW: Failed opportunities to reduce morbidity and mortality occur when evidence-based therapies are not fully implemented in clinical practice. We reviewed the recent literature on implementation strategies in the intensive care unit, with particular attention to antibiotic therapy. RECENT FINDINGS: Emphasis in implementation science has shifted to new models that focus more on direct, point-of-care interaction with providers as opposed to an administrative or top-down approach. Prompting physicians to use a multifaceted checklist was associated with a decrease in severity-adjusted mortality and length of stay. The majority of the benefit appears to correlate with decreased use of empirical antibiotics. A subsequent study demonstrated that face-to-face prompting regarding empirical antibiotics alone was still superior to an electronic checklist, but that long-term changes in use of empirical antibiotics resulted from the previous prompting study. Other studies demonstrate that checklists result in enhanced communication between caregivers, which may be a major explanation for their benefit. SUMMARY: Newer implementation strategies focused on real-time, point-of-care interventions have been associated with greater impact. The most common of these new interventions is use of checklists. Greater checklist use has led to the realization that a prompting or forcing function is required for optimal benefit. DA - 2013/// PY - 2013 VL - 19 IS - 5 SP - 448 EP - 52 J2 - Curr Opin Crit Care LA - eng SN - 1531-7072 (Electronic) UR - https://pubmed.ncbi.nlm.nih.gov/23995122/ AN - 23995122 Y2 - 0010/01/02/ N1 -RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Humans KW - *Checklist KW - *Intensive Care Units KW - Hospital Mortality KW - Length of Stay/statistics & numerical data KW - Critical Care/*methods KW - Anti-Bacterial Agents KW - Anti-Bacterial Agents/*administration & dosage KW - Drug Utilization/*statistics & numerical data KW - Electronic Health Records KW - Practice Patterns, Physicians'/*statistics & numerical data ER - TY - JOUR TI - Systematic review of safety checklists for use by medical care teams in acute hospital settings--limited evidence of effectiveness. AU - Ko HC AU - Turner TJ AU - Finnigan MA T2 - BMC health services research AB - BACKGROUND: Patient safety is a fundamental component of good quality health care. Checklists have been proposed as a method of improving patient safety. This systematic review, asked "In acute hospital settings, would the use of safety checklists applied by medical care teams, compared to not using checklists, improve patient safety?" METHODS: We searched the Cochrane Library, MEDLINE, CINAHL, and EMBASE for randomised controlled trials published in English before September 2009. Studies were selected and appraised by two reviewers independently in consultation with colleagues, using inclusion, exclusion and appraisal criteria established a priori. RESULTS: Nine cohort studies with historical controls studies from four hospital care settings were included-intensive care unit, emergency department, surgery, and acute care. The studies used a variety of designs of safety checklists, and implemented them in different ways, however most incorporated an educational component to teach the staff how to use the checklist. The studies assessed outcomes occurring a few weeks to a maximum of 12 months post-implementation, and these outcomes were diverse.The studies were generally of low to moderate quality and of low levels of evidence, with all but one of the studies containing a high risk of bias.The results of these studies suggest some improvements in patient safety arising from use of safety checklists, but these were not consistent across all studies or for all outcomes. Some studies showed no difference in outcomes between checklist use and standard care without a checklist. Due to the variations in setting, checklist design, educational training given, and outcomes measured, it was unfeasible to accurately summarise any trends across all studies. CONCLUSIONS: The included studies suggest some benefits of using safety checklists to improve protocol adherence and patient safety, but due to the risk of bias in these studies, their results should be interpreted with caution. More high quality and studies, are needed to enable confident conclusions about the effectiveness of safety checklists in acute hospital settings. DA - 2011/// PY - 2011 VL - 11 SP - 211 J2 - BMC Health Serv Res LA - eng SN - 1472-6963 (Electronic) UR - https://pubmed.ncbi.nlm.nih.gov/21884618/ AN - 21884618 Y2 - 0009/01/02/ N1 -RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Humans KW - Female KW - Male KW - Treatment Outcome KW - Hospitals, Special KW - Checklist/*standards KW - Patient Care Team KW - Quality of Health Care KW - *Patient Safety KW - Critical Care/standards KW - Patient Care Team/*standards KW - Safety Management/standards KW - Victoria ER - TY - JOUR TI - Use of a daily goals checklist for morning ICU rounds: a mixed-methods study. AU - Centofanti JE AU - Duan EH AU - Hoad NC AU - Swinton ME AU - Perri D AU - Waugh L AU - Cook DJ T2 - Critical care medicine AB - OBJECTIVE: To understand the perspectives and attitudes of ICU clinicians about use of a daily goals checklist on rounds. DESIGN: Our three data collection methods were as follows: (1) Field observations: two investigators conducted field observations to understand how and by whom the daily goals checklist was used for 80 ICU patient rounds over 6 days. (2) Document analysis: The 72 completed daily goals checklists from observed rounds were analyzed using mixed methods. (3) Interviews: With 56 clinicians, we conducted semistructured individual and focus-group interviews, analyzing transcripts using a qualitative descriptive approach and content analysis. Triangulation was achieved by a multidisciplinary investigative team using two research methods and three data sources. SETTING: Fifteen bed closed ICU in a tertiary care, university-affiliated hospital. PATIENTS: Medical-surgical ICU patients. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Field observations: The daily goals checklist was completed for 93% of observed rounds, largely by residents (86%). The champion of the verbal review was commonly a resident (83%) or medical student (9%). Document analysis: Domains with high completion rates included ventilation, sedation, central venous access, nutrition, and various prophylactic interventions. Interviews: The daily goals checklist enhanced communication, patient care, and education. Nurses, physicians, and pharmacists endorsed its enhancement of interdisciplinary communication. It facilitated a structured, thorough, and individualized approach to patient care. The daily goals checklist helped to identify new patient care issues and sparked management discussions, especially for sedation, weaning, and medications. Residents were prominent users, finding served as a multipurpose teaching tool. CONCLUSIONS: The daily goals checklist was perceived to improve the management of critically ill patients by creating a systematic, comprehensive approach to patient care and by setting individualized daily goals. Reportedly improving interprofessional communication and practice, the daily goals checklist also enhanced patient safety and daily progress, encouraging momentum in recovery from critical illness. Daily goals checklist review prompted teaching opportunities for multidisciplinary learners on morning rounds. DA - 2014/// PY - 2014 VL - 42 IS - 8 SP - 1797 EP - 803 J2 - Crit Care Med LA - eng SN - 1530-0293 (Electronic) UR - https://pubmed.ncbi.nlm.nih.gov/24674928/ AN - 24674928 Y2 - 0008/01/02/ N1 -RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Humans KW - Aged KW - Middle Aged KW - Critical Illness KW - *Checklist KW - Intensive Care Units/*organization & administration KW - Critical Care/*methods KW - Hospitals, University KW - *Attitude of Health Personnel KW - Focus Groups KW - Goals KW - Interdisciplinary Communication KW - Physicians/*psychology KW - Students, Medical/*psychology KW - Teaching Rounds/*organization & administration KW - Tertiary Care Centers ER - TY - JOUR TI - Prompting physicians to address a daily checklist and process of care and clinical outcomes: a single-site study. AU - Weiss CH AU - Moazed F AU - McEvoy CA AU - Singer BD AU - Szleifer I AU - Amaral LA AU - Kwasny M AU - Watts CM AU - Persell SD AU - Baker DW AU - Sznajder JI AU - Wunderink RG T2 - American journal of respiratory and critical care medicine AB - RATIONALE: Checklists may reduce errors of omission for critically ill patients. OBJECTIVES: To determine whether prompting to use a checklist improves process of care and clinical outcomes. METHODS: We conducted a cohort study in the medical intensive care unit (MICU) of a tertiary care university hospital. Patients admitted to either of two independent MICU teams were included. 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. MEASUREMENTS AND MAIN RESULTS: One hundred and forty prompted group patients were compared with 125 control and 1,283 preintervention patients. Compared with control, prompting increased median ventilator-free duration, decreased empirical antibiotic and central venous catheter duration, and increased rates of deep vein thrombosis and stress ulcer prophylaxis. Prompted group patients had lower risk-adjusted ICU mortality compared with the control group (odds ratio, 0.36; 95% confidence interval, 0.13-0.96; P = 0.041) and lower hospital mortality compared with the control group (10.0 vs. 20.8%; P = 0.014), which remained significant after risk adjustment (odds ratio, 0.34; 95% confidence interval, 0.15-0.76; P = 0.008). Observed-to-predicted ICU length of stay was lower in the prompted group compared with control (0.59 vs. 0.87; P = 0.02). Checklist availability alone did not improve mortality or length of stay compared with preintervention patients. CONCLUSIONS: In this single-site, preliminary study, checklist-based prompting improved multiple processes of care, and may have improved mortality and length of stay, compared with a stand-alone checklist. The manner in which checklists are implemented is of great consequence in the care of critically ill patients. DA - 2011/// PY - 2011 VL - 184 IS - 6 SP - 680 EP - 6 J2 - Am J Respir Crit Care Med LA - eng SN - 1535-4970 (Electronic) UR - https://pubmed.ncbi.nlm.nih.gov/21616996/ AN - 21616996 Y2 - 0009/01/02/ N1 -RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Humans KW - Female KW - Male KW - Middle Aged KW - Prospective Studies KW - Intensive Care Units KW - Length of Stay KW - Critical Illness KW - *Guideline Adherence KW - Cohort Studies KW - Hospital Mortality KW - Checklist/*methods KW - Hospitals, University KW - *Cues KW - *Physicians KW - Odds Ratio KW - Outcome and Process Assessment, Health Care/*methods ER - TY - JOUR TI - Clinician perceptions of operating room to intensive care unit handoffs and implications for patient safety: a qualitative study. AU - McElroy LM AU - Macapagal KR AU - Collins KM AU - Abecassis MM AU - Holl JL AU - Ladner DP AU - Gordon EJ T2 - American journal of surgery AB - BACKGROUND: Operating room (OR) to the intensive care unit (ICU) handoffs are known sources of medical error, yet little is known about the relationship between process failures and patient harm. METHODS: Interviews were conducted with clinicians involved in the OR-to-ICU handoff to characterize the relationship between handoff process failures and patient harm. Qualitative analysis was used to inductively identify key themes. RESULTS: A total of 38 interviews were conducted. Dominant themes included early communication from the OR to the ICU, team member participation in the handoff, and relationships between clinicians; clinician perspectives varied depending substantially on role within the team. CONCLUSIONS: The findings suggest that ambiguous roles and conflicting expectations of team members during the OR-to-ICU handoff can increase risk of patient harm. Future studies should investigate early postoperative ICU care as outcome markers of handoff quality and the effect of interprofessional education on clinician adherence to interventions. DA - 2015/// PY - 2015 VL - 210 IS - 4 SP - 629 EP - 35 J2 - Am J Surg LA - eng SN - 1879-1883 (Electronic) UR - https://pubmed.ncbi.nlm.nih.gov/26198333/ AN - 26198333 Y2 - 0010/01/02/ N1 -RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Humans KW - Communication KW - *Intensive Care Units KW - *Patient Handoff KW - Checklist KW - *Patient Safety KW - *Operating Rooms KW - Qualitative Research KW - *Attitude of Health Personnel KW - *Patient Transfer KW - Grounded Theory KW - Interprofessional Relations ER - TY - JOUR TI - Checklists change communication about key elements of patient care. AU - Newkirk M AU - Pamplin JC AU - Kuwamoto R AU - Allen DA AU - Chung KK T2 - The journal of trauma and acute care surgery AB - BACKGROUND: Combat casualty care is distributed across professions and echelons of care. Communication within it is fragmented, inconsistent, and prone to failure. Daily checklists used during intensive care unit (ICU) rounds have been shown to improve compliance with evidence-based practices, enhance communication, promote consistency of care, and improve outcomes. Checklists are criticized because it is difficult to establish a causal link between them and their effect on outcomes. We investigated how checklists used during ICU rounds affect communication. METHODS: We conducted this project in two military ICUs (burn and surgical/trauma). Checklists contained up to 21 questions grouped according to patient population. We recorded which checklist items were discussed during rounds before and after implementation of a "must address" checklist and compared the frequency of discussing items before checklist prompting. RESULTS: Patient discussions addressed more checklist items before prompting at the end of the 2-week evaluation compared with the 2-week preimplementation period (surgical trauma ICU, 36% vs. 77%, p < 0.0001; burn ICU, 47% vs. 72 %, p < 0.001). Most items were addressed more frequently in both ICUs after implementation. Key items such as central line removal, reduction of laboratory testing, medication reconciliation, medication interactions, bowel movements, sedation holidays, breathing trials, and lung protective ventilation showed significant improvements. CONCLUSION: Checklists modify communication patterns. Improved communication facilitated by checklists may be one mechanism behind their effectiveness. Checklists are powerful tools that can rapidly alter patient care delivery. Implementing checklists could facilitate the rapid dissemination of clinical practice changes, improve communication between echelons of care and between individuals involved in patient care, and reduce missed information. DA - 2012/// PY - 2012 VL - 73 IS - 2 SP - S75 EP - 82 J2 - J Trauma Acute Care Surg LA - eng SN - 2163-0763 (Electronic) UR - https://pubmed.ncbi.nlm.nih.gov/22847100/ AN - 22847100 Y2 - 0008/01/02/ N1 -RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Humans KW - Intensive Care Units KW - Communication KW - *Checklist KW - Quality of Health Care KW - United States KW - Continuity of Patient Care KW - *Critical Care/methods KW - *Military Medicine/methods ER - TY - JOUR TI - Adherence to the items in a bundle for the prevention of ventilator-associated pneumonia. AU - Sachetti A AU - Rech V AU - Dias AS AU - Fontana C AU - Barbosa Gda L AU - Schlichting D T2 - Revista Brasileira de terapia intensiva AB - OBJECTIVE: To assess adherence to a ventilator care bundle in an intensive care unit and to determine the impact of adherence on the rates of ventilator-associated pneumonia. METHODS: A total of 198 beds were assessed for 60 days using a checklist that consisted of the following items: bed head elevation to 30 to 45º; position of the humidifier filter; lack of fluid in the ventilator circuit; oral hygiene; cuff pressure; and physical therapy. Next, an educational lecture was delivered, and 235 beds were assessed for the following 60 days. Data were also collected on the incidence of ventilator-acquired pneumonia. RESULTS: Adherence to the following ventilator care bundle items increased: bed head elevation from 18.7% to 34.5%; lack of fluid in the ventilator circuit from 55.6% to 72.8%; oral hygiene from 48.5% to 77.8%; and cuff pressure from 29.8% to 51.5%. The incidence of ventilator-associated pneumonia was statistically similar before and after intervention (p=0.389). CONCLUSION: The educational intervention performed in this study increased the adherence to the ventilator care bundle, but the incidence of ventilator-associated pneumonia did not decrease in the small sample that was assessed. DA - 2014/// PY - 2014 VL - 26 IS - 4 SP - 355 EP - 9 J2 - Rev Bras Ter Intensiva LA - ["eng", "por"] SN - 1982-4335 (Electronic) UR - https://pubmed.ncbi.nlm.nih.gov/25607263/ AN - 25607263 Y2 - 0010/01/02/ N1 -RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Humans KW - Cross-Sectional Studies KW - *Intensive Care Units KW - Checklist KW - *Guideline Adherence KW - Ventilators, Mechanical KW - *Practice Guidelines as Topic KW - Pneumonia, Ventilator-Associated/*prevention & control ER - TY - JOUR TI - Handoffs and transitions in critical care (HATRICC): protocol for a mixed methods study of operating room to intensive care unit handoffs. AU - Lane-Fall MB AU - Beidas RS AU - Pascual JL AU - Collard ML AU - Peifer HG AU - Chavez TJ AU - Barry ME AU - Gutsche JT AU - Halpern SD AU - Fleisher LA AU - Barg FK T2 - BMC surgery AB - BACKGROUND: Operating room to intensive care unit handoffs are high-risk events for critically ill patients. Studies in selected patient populations show that standardizing operating room to intensive care unit handoffs improves information exchange and decreases errors. To adapt these findings to mixed surgical populations, we propose to study the implementation of a standardized operating room to intensive care unit handoff process in two intensive care units currently without an existing standard process. METHODS/DESIGN: The Handoffs and Transitions in Critical Care (HATRICC) study is a hybrid effectiveness- implementation trial of operating room to intensive care unit handoffs. We will use mixed methods to conduct a needs assessment of the current handoff process, adapt published handoff processes, and implement a new standardized handoff process in two academic intensive care units. Needs assessment: We will use non-participant observation to observe the current handoff process. Focus groups, interviews, and surveys of clinicians will elicit participants' impressions about the current process. Adaptation and implementation: We will adapt published standardized handoff processes using the needs assessment findings. We will use small group simulation to test the new process' feasibility. After simulation, we will incorporate the new handoff process into the clinical work of all providers in the study units. EVALUATION: Using the same methods employed in the needs assessment phase, we will evaluate use of the new handoff process. DATA ANALYSIS: The primary effectiveness outcome is the number of information omissions per handoff episode as compared to the pre-intervention period. Additional intervention outcomes include patient intensive care unit length of stay and intensive care unit mortality. The primary implementation outcome is acceptability of the new process. Additional implementation outcomes include feasibility, fidelity and sustainability. DISCUSSION: The HATRICC study will examine the effectiveness and implementation of a standardized operating room to intensive care unit handoff process. Findings from this study have the potential to improve healthcare communication and outcomes for critically ill patients. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02267174. Date of registration October 16, 2014. DA - 2014/// PY - 2014 VL - 14 SP - 96 J2 - BMC Surg LA - eng SN - 1471-2482 (Electronic) UR - https://pubmed.ncbi.nlm.nih.gov/25410548/ AN - 25410548 Y2 - 0011/01/02/ N1 -RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Humans KW - Intensive Care Units KW - Intensive Care Units/*standards KW - Checklist KW - Surveys and Questionnaires KW - Critical Care/*standards KW - Medical Errors/prevention & control KW - *Clinical Protocols KW - Continuity of Patient Care/*standards KW - Needs Assessment KW - Operating Rooms/*standards KW - Patient Transfer/*methods KW - Perioperative Care/standards ER - TY - JOUR TI - Impact of a multidisciplinary checklist on the duration of invasive mechanical ventilation and length of ICU stay. AU - Barcellos RA AU - Chatkin JM T2 - Jornal brasileiro de pneumologia : publicacao oficial da Sociedade Brasileira de Pneumologia e Tisilogia AB - OBJECTIVE: To assess the impact that implementing a checklist during daily multidisciplinary rounds has on the duration of invasive mechanical ventilation (IMV) and length of ICU stay. METHODS: This was a non-randomized clinical trial in which the pre-intervention and post-intervention duration of IMV and length of ICU stay were evaluated in a total of 466 patients, including historical controls, treated in three ICUs of a hospital in the city of Caxias do Sul, Brazil. We evaluated 235 and 231 patients in the pre-intervention and post-intervention periods, respectively. The following variables were studied: age; gender; cause of hospitalization; diagnosis on admission; comorbidities; the Simplified Acute Physiology Score 3; the Sequential Organ Failure Assessment score; days in the ICU; days on IMV; reintubation; readmission; in-hospital mortality; and ICU mortality. RESULTS: After the implementation of the checklist, the median (interquartile range) for days in the ICU and for days on IMV decreased from 8 (4-17) to 5 (3-11) and from 5 (1-12) to 2 (< 1-7), respectively, and the differences were significant (p ≤ 0.001 for both). CONCLUSIONS: The implementation of the checklist during daily multidisciplinary rounds was associated with a reduction in the duration of IMV and length of ICU stay among the patients in our sample. DA - 2020/// PY - 2020 VL - 46 IS - 3 SP - e20180261 J2 - J Bras Pneumol LA - ["eng", "por"] SN - 1806-3756 (Electronic) UR - https://pubmed.ncbi.nlm.nih.gov/32236341/ AN - 32236341 N1 -RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Humans KW - Brazil KW - *Checklist KW - Respiration, Artificial KW - Ventilators, Mechanical KW - Intensive Care Units/statistics & numerical data KW - Outcome and Process Assessment, Health Care KW - Length of Stay/*statistics & numerical data KW - Respiration, Artificial/methods/*standards ER - TY - JOUR TI - Evaluation of an evidence-based, nurse-driven checklist to prevent hospital-acquired catheter-associated urinary tract infections in intensive care units. AU - Fuchs MA AU - Sexton DJ AU - Thornlow DK AU - Champagne MT T2 - Journal of nursing care quality AB - Catheter-associated urinary tract infections account for 40% of all health care-associated infections. An evidence-based, nurse-driven daily checklist for initiation and continuance of urinary catheters was implemented in 5 adult intensive care units. Measures of compliance, provider satisfaction, and clinical outcomes were recorded. Compliance with the checklist was 50 to 100%: catheter-associated urinary tract infections decreased from 2.88 to 1.46 per 1000 catheter days and catheter days decreased in 2 intensive care units. DA - 2011/// PY - 2011 VL - 26 IS - 2 SP - 101 EP - 9 J2 - J Nurs Care Qual LA - eng SN - 1550-5065 (Electronic) UR - https://pubmed.ncbi.nlm.nih.gov/21037484/ AN - 21037484 Y2 - 0004/01/02/ N1 -RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Humans KW - Retrospective Studies KW - Infection Control/*methods KW - Urinary Tract Infections KW - Guideline Adherence/statistics & numerical data KW - Checklist/*methods KW - Critical Care/methods KW - Health Care Surveys KW - Cross Infection/nursing/prevention & control KW - Evidence-Based Nursing/*methods KW - Medical Staff, Hospital KW - Nurse Practitioners KW - Nursing Staff, Hospital KW - Physician Assistants KW - Urinary Catheterization/adverse effects/nursing KW - Urinary Tract Infections/*nursing/*prevention & control ER - TY - JOUR TI - The Future of Critical Care Medicine: Integration and Personalization. AU - Vincent JL T2 - Critical care medicine DA - 2016/// PY - 2016 VL - 44 IS - 2 SP - 386 EP - 9 J2 - Crit Care Med LA - eng SN - 1530-0293 (Electronic) UR - https://pubmed.ncbi.nlm.nih.gov/26771785/ AN - 26771785 Y2 - 0002/01/02/ N1 -RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Humans KW - Checklist KW - Intensive Care Units/*organization & administration KW - Critical Care/*organization & administration KW - Clinical Protocols KW - Precision Medicine/*methods ER - TY - JOUR TI - Quality improvement of doctors' shift-change handover in neuro-critical care. AU - Lyons MN AU - Standley TD AU - Gupta AK T2 - Quality & safety in health care AB - BACKGROUND: Clinical handover is a necessary process for the continuation of safe patient care; however, deficiencies in the handover process can introduce error. While the number of handover studies increases, few have validated implemented improvements with repeated audit. OBJECTIVE: To improve the morning handover round on a busy critical care unit and assess sustainability of improvement through repeated audit. DESIGN/METHODS: A quality improvement process based on prospective observational assessment of the doctor's shift-change handover was carried out, assessing the content of clinical information and effects of distractions, location and timing. The effect of a training session for the junior doctors with the introduction of a standardised handover protocol was assessed. RESULTS: The content of clinical information improved after the training session with introduction of a standardised protocol, but returned to baseline with a new cohort of untrained doctors. Distractions were associated with increased handover times for individual patients and for total handover time. Overall, handover time was shortest in the coffee room compared with ward and lecture theatre handovers. Individual patient handover time was positively correlated with clinical content scores. Four indices of critical illness all positively correlated with increased handover time. CONCLUSIONS: Early specific training is vital for quality clinical handover. Distractions during handover cause inefficiency and can adversely affect information transfer. Changing handover location according to local environment can yield improved efficiency, structure and ease of management. Adequate time must be allocated for clinical handover especially when dealing with very sick and complex patients. DA - 2010/// PY - 2010 VL - 19 IS - 6 SP - e62 J2 - Qual Saf Health Care LA - eng SN - 1475-3901 (Electronic) UR - https://pubmed.ncbi.nlm.nih.gov/20427308/ AN - 20427308 Y2 - 0012/01/02/ N1 -RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Humans KW - Prospective Studies KW - United Kingdom KW - Critical Care KW - Checklist KW - *Critical Care KW - Medical Audit KW - Interviews as Topic KW - *Nervous System Diseases KW - *Physician's Role KW - Observation KW - Patient Transfer/*organization & administration KW - Quality Assurance, Health Care/*methods KW - Workforce ER - TY - JOUR TI - Effect of Compliance With a Nurse-Led Intensive Care Unit Checklist on Clinical Outcomes in Mechanically and Nonmechanically Ventilated Patients. AU - Al Ashry HS AU - Abuzaid AS AU - Walters RW AU - Modrykamien AM T2 - Journal of intensive care medicine AB - BACKGROUND: Use of checklists brings about improvements in a variety of patient outcomes. Nevertheless, whether compliance with a nurse-led intensive care unit (ICU) checklist produces the same effect is currently unknown. METHODS: This is a retrospective analysis of data obtained during the implementation of a quality improvement project consisting of the utilization of a nurse-led ICU checklist. A consecutive series of checklists obtained from patients admitted in our ICU during 7 consecutive months were included. The ICU stay, hospital stay, and ventilator stay were compared between patients whose practitioners completed or did not complete the checklist. Variables were analyzed using Mann-Whitney U tests for continuous variables and Fisher exact tests for categorical variables. A 2-tailed P < .05 was considered statistically significant. RESULTS: One thousand checklists, corresponding to 346 eligible patients, were collected over 7 months. Mechanical ventilation was used in 203 (59%) patients. Completed checklists were observed for 37.6% (n = 130) of all patients and 38.9% (n = 79) of mechanically ventilated patients. After adjusting for age, Acute Physiology and Chronic Health Evaluation II (APACHE II), body mass index, reason for admission, and type of ICU, completion of the checklist was associated with a 20% increase in the number of days in the ICU compared with the group with incomplete lists. In mechanically ventilated patients, completion of the checklist was associated with a 31% increase in hospital length of stay, a 34% increase in the number of ICU days, and a 32% increase in mechanical ventilation days. CONCLUSION: Compliance with completion of a nurse-led ICU checklist was associated with prolonged ICU stay, hospital stay, and ventilator stay. DA - 2016/// PY - 2016 VL - 31 IS - 4 SP - 252 EP - 7 J2 - J Intensive Care Med LA - eng SN - 1525-1489 (Electronic) UR - https://pubmed.ncbi.nlm.nih.gov/24825860/ AN - 24825860 Y2 - 0005/01/02/ N1 -RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Humans KW - Female KW - Male KW - Retrospective Studies KW - Aged KW - Middle Aged KW - Length of Stay KW - Checklist/*standards KW - *Guideline Adherence KW - Ventilators, Mechanical KW - APACHE KW - Intensive Care Units/*organization & administration KW - Outcome and Process Assessment, Health Care KW - *Practice Patterns, Nurses' KW - Critical Care Nursing/methods/organization & administration/*standards KW - Respiration, Artificial/*nursing KW - Statistics, Nonparametric ER - TY - JOUR TI - Achieving zero central line-associated bloodstream infection rates in your intensive care unit. AU - Sagana R AU - Hyzy RC T2 - Critical care clinics AB - Central line-associated bloodstream infection (CLABSI) is one of the most common health care-associated infections in the United States. The costs associated with CLABSIs include an estimated 28,000 deaths in the intensive care unit and up to $2.3 billion annually. Best practice guidelines, checklists, and establishing a culture of safety in hospitals are all initiatives designed to reduce the rate of CLABSI to zero. DA - 2013/// PY - 2013 VL - 29 IS - 1 SP - 1 EP - 9 J2 - Crit Care Clin LA - eng SN - 1557-8232 (Electronic) UR - https://pubmed.ncbi.nlm.nih.gov/23182523/ AN - 23182523 Y2 - 0001/01/02/ N1 -RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Humans KW - Intensive Care Units KW - Hospital Mortality KW - United States KW - Practice Guidelines as Topic KW - Organizational Culture KW - Quality Indicators, Health Care KW - Bacteremia/economics/etiology/mortality/*prevention & control KW - Catheter-Related Infections/economics/mortality/*prevention & control KW - Catheterization, Central Venous/*adverse effects/economics/standards KW - Checklist/methods/standards KW - Cross Infection/economics/etiology/mortality/*prevention & control KW - Intensive Care Units/economics/organization & administration/standards KW - Medicare/economics/standards KW - Reimbursement Mechanisms/standards/trends KW - Safety Management/organization & administration/standards ER - TY - JOUR TI - A program to improve the quality of emergency endotracheal intubation. AU - Mayo PH AU - Hegde A AU - Eisen LA AU - Kory P AU - Doelken P T2 - Journal of intensive care medicine AB - OBJECTIVE: To assess the results of a quality improvement (QI) project designed to improve safety of emergency endotracheal intubation (EEI). DESIGN: Single center prospective observational. SETTING: 16-bed intensive care unit. PARTICIPANTS: Nine pulmonary/critical care fellows. INTERVENTIONS: For 3 years, EEI performed by the medical intensive care unit team were analyzed to identify interventions that would improve quality of the procedure. By segmental process analysis, the procedure of EEI was subjected to iterative change. Major components of process improvement were development of a combined team approach, a mandatory checklist, use of crew resource management (CRM) tactics, and postevent debriefing. Quality analysis and improvement included training of fellows using scenario-based training (SBT) with computerized patient simulator (CPS) to improve mechanical skills of intubation and team leadership. Fellows received 15 sessions of SBT with CPS using a combined checklist and team approach before assuming team leadership position during real-life EEI. MEASUREMENTS: For a 10-month period, fellows carried digital voice recorders to EEI; which, when combined with recording of continuous oximetry and BP monitoring were used to assess the quality of EEI. MAIN RESULTS: 128 EEI were performed of which 101 had full data recorded. Complications were 14% severe hypoxemia (<80% saturation), 6% severe hypotension (SBP<70 mm Hg), 1% death, 20% difficult EEI (≥ 3 attempts), 11% esophageal intubations, 2% aspiration, and 1% dental injury; 62% EEI were successfully achieved on first attempt, 11% required >3 attempts. CONCLUSIONS: EEI may be performed by pulmonary/critical medicine (PCCM) fellows with safety comparable to that described in other studies on EEI. Important parts of the program included the use of formal iterative QI approach, the use of intensive SBT with CPS, basic CRM, a comprehensive checklist, and a combined team approach. A key benefit of the program was to make the process of EEI fully transparent for ongoing quality and safety improvement. DA - 2011/// PY - 2011 VL - 26 IS - 1 SP - 50 EP - 6 J2 - J Intensive Care Med LA - eng SN - 1525-1489 (Electronic) UR - https://pubmed.ncbi.nlm.nih.gov/21262753/ AN - 21262753 Y2 - 0001/01/02/ N1 -RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Humans KW - Adult KW - Intensive Care Units KW - Emergencies KW - Checklist KW - Clinical Competence KW - Intubation, Intratracheal KW - Patient Care Team/*standards KW - *Quality Assurance, Health Care KW - Education, Medical, Continuing/methods KW - Emergency Treatment/*standards KW - Intubation, Intratracheal/*standards KW - Patient Simulation ER - TY - JOUR TI - Aseptic insertion of central venous lines to reduce bacteraemia. AU - Burrell AR AU - McLaws ML AU - Murgo M AU - Calabria E AU - Pantle AC AU - Herkes R T2 - The Medical journal of Australia AB - OBJECTIVE: To reduce the rate of central line-associated bacteraemia (CLAB). DESIGN: A collaborative quality improvement project in intensive care units (ICUs) to promote aseptic insertion of central venous lines (CVLs). A checklist was used to record compliance with all aspects of aseptic CVL insertion, with maximal sterile barrier precautions for clinicians ("clinician bundle") and patients ("patient bundle"). CLAB was identified and reported using a standard surveillance definition. PARTICIPANTS AND SETTING: Patients and clinicians in 37 ICUs in New South Wales, July 2007-December 2008. MAIN OUTCOME MEASURES: Compliance with aseptic CVL insertion; rates of CLAB. RESULTS: 10 890 CVL checklists were reviewed for compliance with the clinician and patient bundles: compliance with aseptic CVL insertion improved significantly (P < 0.001). The CLAB rate dropped from 3.0 to 1.2 per 1000 line-days (P < 0.001). Regardless of CVL type, the relative risk (RR) of CLAB in patients with CVLs inserted by clinicians not compliant with the clinician bundle was 1.62 times greater (95% CI, 1.1-2.4; P = 0.018) than the RR with CVLs inserted by clinicians compliant with both bundles. Compliance with both the bundles was associated with a 50% reduction in risk of CLAB (RR, 0.5; 95% CI, 0.4-0.8; P = 0.004). CONCLUSIONS: Compliance with all aspects of aseptic CVL insertion significantly reduces the risk of CLAB. A difficulty we experienced was that most ICUs lacked the organisation and staff to support quality improvement and audit. DA - 2011/// PY - 2011 VL - 194 IS - 11 SP - 583 EP - 7 J2 - Med J Aust LA - eng SN - 1326-5377 (Electronic) UR - https://pubmed.ncbi.nlm.nih.gov/21644871/ AN - 21644871 Y2 - 0006/01/02/ N1 -RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Humans KW - Intensive Care Units KW - Critical Care KW - Checklist KW - *Quality Improvement KW - Australia/epidemiology KW - Bacteremia/epidemiology/etiology/*prevention & control KW - Catheterization, Central Venous/*adverse effects KW - Catheters, Indwelling/*microbiology KW - Clinical Audit KW - Infection Control/*methods/standards KW - Practice Patterns, Physicians' ER - TY - JOUR TI - The relationship of 26 clinical factors to weaning outcome. AU - Burns SM AU - Fisher C AU - Tribble SE AU - Lewis R AU - Merrel P AU - Conaway MR AU - Bleck TP T2 - American journal of critical care : an official publication, American Association of Critical-Care Nurses AB - BACKGROUND: The Burns Wean Assessment Program (BWAP) assessment checklist is designed to assist clinicians in the systematic evaluation of 26 clinical factors important to weaning. The authors recently described the relationship of the BWAP score (derived from the checklist) to weaning trial outcomes (weaning success or failure) in patients receiving mechanical ventilation for 3 days or longer in 5 adult critical care units. A BWAP score of 50 or higher was significantly associated with weaning success regardless of the specific category of patient (surgical, medical, cardiovascular, etc). This secondary analysis extends the evaluation of the BWAP checklist as it focuses on the importance of each individual BWAP factor to weaning outcomes in 5 different populations of patients. OBJECTIVES: To identify the relative importance of the 26 BWAP factors to weaning success in patients undergoing mechanical ventilation for 3 days or longer in 5 adult critical care units. METHODS: BWAP checklists were completed within 24 hours of a weaning attempt in surgical-trauma, medical, neurological, thoracic-cardiovascular, and coronary care units in a 5-year period. Advanced practice nurses using a multidisciplinary pathway, the BWAP checklist, protocols for weaning trials, and sedation guidelines managed the patients similarly. RESULTS: A total of 20 BWAP factors were significantly associated with successful weaning in all units combined (P ≤ .02). However, some differences in the importance of the BWAP factors to weaning outcome exist between units, with the neuroscience intensive care unit deviating the most from the other units. CONCLUSIONS: Although not all BWAP factors are significantly associated with weaning success, most are predictive. Restructuring the BWAP as a unit-specific weaning checklist and potential predictor may assist clinicians to address factors that may impede weaning more efficiently and effectively. DA - 2012/// PY - 2012 VL - 21 IS - 1 SP - 52 EP - 8; quiz 59 J2 - Am J Crit Care LA - eng SN - 1937-710X (Electronic) UR - https://pubmed.ncbi.nlm.nih.gov/22210700/ AN - 22210700 Y2 - 0001/01/02/ N1 -RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Humans KW - Adult KW - Female KW - Male KW - Aged KW - Middle Aged KW - Intensive Care Units KW - Length of Stay KW - Academic Medical Centers KW - Checklist KW - Aged, 80 and over KW - Young Adult KW - Outcome and Process Assessment, Health Care KW - Critical Care/*methods KW - Time Factors KW - *Respiration, Artificial KW - Advanced Practice Nursing KW - Nursing Assessment/*methods KW - Nursing Care KW - Predictive Value of Tests KW - Ventilator Weaning/*methods ER - TY - JOUR TI - Often overlooked problems with handoffs: from the intensive care unit to the operating room. AU - Evans AS AU - Yee MS AU - Hogue CW T2 - Anesthesia and analgesia DA - 2014/// PY - 2014 VL - 118 IS - 3 SP - 687 EP - 9 J2 - Anesth Analg LA - eng SN - 1526-7598 (Electronic) UR - https://pubmed.ncbi.nlm.nih.gov/24413554/ AN - 24413554 Y2 - 0003/01/02/ N1 -RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Humans KW - Intensive Care Units KW - Intensive Care Units/*standards KW - Patient Handoff/*standards KW - Checklist/methods/standards KW - Operating Rooms/methods/*standards ER - TY - JOUR TI - Measurable outcomes of quality improvement using a daily quality rounds checklist: two-year prospective analysis of sustainability in a surgical intensive care unit. AU - Teixeira PG AU - Inaba K AU - Dubose J AU - Melo N AU - Bass M AU - Belzberg H AU - Demetriades D T2 - The journal of trauma and acute care surgery AB - BACKGROUND: The use of a "quality rounds checklist" (QRC) is an effective tool for improving compliance with evidence-based preventative measures and outcomes in the surgical intensive care unit (SICU). Our aim was to evaluate the long-term sustainability and outcome impact of this quality improvement strategy. METHODS: Prospective observational study evaluates the use of the QRC in the SICU from July 2009 to June 2011. Daily compliance with evidence-based prophylactic measures was assessed using the QRC and reviewed monthly at a multidisciplinary meeting. Logistic regression was performed to evaluate patterns of compliance over time. Current compliance was compared with previously reported rates, and the impact on outcomes including catheter-related blood stream infection and ventilator-associated pneumonia rates was examined. RESULTS: Over 2 years, 2,472 patients were admitted to the SICU. Mean (SD) age was 42.2 (22.4) years, 79% were male, and 35% had an Injury Severity Score (ISS) of greater than 15. The rate of compliance with head-of-bed elevation significantly improved during the study period (p = 0.01 for trend), with an overall compliance of 97%. Both deep venous thrombosis prophylaxis and gastrointestinal bleed prophylaxis compliance remained stable, with overall rates of 98% and 96%, respectively. The use of sedation holidays also remained stable, with an overall compliance rate of 94%. Compared with our previously published data, the compliance rates with preventative measures were stable or significantly improved; the incidence of catheter-related blood stream infections was lower (0.85/1,000 vs. 4.98/1,000 catheter days, p < 0.001); and the incidence of ventilator-associated pneumonia downtrended (1.66/1,000 vs. 8.74/1,000 ventilator days, p = 0.07). CONCLUSION: Two years after implementation of a QRC, sustainable high rates of compliance with clinically relevant preventative measures in a SICU was demonstrated with minimal fading of clinically relevant outcomes. LEVEL OF EVIDENCE: Therapeutic study, level IV. DA - 2013/// PY - 2013 VL - 75 IS - 4 SP - 717 EP - 21 J2 - J Trauma Acute Care Surg LA - eng SN - 2163-0763 (Electronic) UR - https://pubmed.ncbi.nlm.nih.gov/24064888/ AN - 24064888 Y2 - 0010/01/02/ N1 -RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Humans KW - Adult KW - Female KW - Male KW - Prospective Studies KW - Intensive Care Units KW - Quality Improvement/*organization & administration/standards KW - Checklist KW - Guideline Adherence/statistics & numerical data KW - Quality Indicators, Health Care KW - Catheter-Related Infections/epidemiology KW - Critical Care/methods/organization & administration/standards KW - Gastrointestinal Hemorrhage/prevention & control KW - Intensive Care Units/*standards/statistics & numerical data KW - Outcome and Process Assessment, Health Care/methods KW - Outcome Assessment (Health Care) KW - Pneumonia, Ventilator-Associated/epidemiology KW - Venous Thrombosis/prevention & control ER - TY - JOUR TI - OR to ICU handoff: theory of change model for sustainable change in behavior. AU - Faiz T AU - Saeed B AU - Ali S AU - Abbas Q AU - Malik M T2 - Asian cardiovascular & thoracic annals DA - 2019/// PY - 2019 VL - 27 IS - 6 SP - 452 EP - 458 J2 - Asian Cardiovasc Thorac Ann LA - eng SN - 1816-5370 (Electronic) UR - https://pubmed.ncbi.nlm.nih.gov/31189326/ AN - 31189326 Y2 - 0007/01/02/ N1 -RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Humans KW - Female KW - Male KW - Adolescent KW - Child KW - Child, Preschool KW - Attitude of Health Personnel KW - *Checklist KW - Quality Improvement KW - Program Evaluation KW - Cooperative Behavior KW - Patient Care Team/*organization & administration KW - *Cardiac Surgical Procedures KW - Operating Rooms/*organization & administration KW - Quality Indicators, Health Care KW - Interdisciplinary Communication KW - Health Knowledge, Attitudes, Practice KW - Heart Defects, Congenital/diagnosis/*surgery KW - Intensive Care Units, Pediatric/*organization & administration KW - Patient Handoff/*organization & administration ER - TY - JOUR TI - Reducing the rate of catheter-associated bloodstream infections in a surgical intensive care unit using the Institute for Healthcare Improvement Central Line Bundle. AU - Sacks GD AU - Diggs BS AU - Hadjizacharia P AU - Green D AU - Salim A AU - Malinoski DJ T2 - American journal of surgery AB - BACKGROUND: Central line-associated bloodstream infections (CLABSIs) are a significant source of morbidity and mortality. This study sought to determine whether implementation of the Institute for Healthcare Improvement (IHI) Central Line Bundle would reduce the incidence of CLABSIs. METHODS: The IHI Central Line Bundle was implemented in a surgical intensive care unit. Patient demographics and the rate of CLABSIs per 1,000 catheter days were compared between the pre- and postintervention groups. Contemporaneous infection rates in an adjacent ICU were measured. RESULTS: Baseline demographics were similar between the pre- and postintervention groups. The rate of CLABSIs per catheter days decreased from 19/3,784 to 3/1,870 after implementation of the IHI Bundle (1.60 vs 5.02 CLABSIs per 1,000 catheter days; rate ratio .32 [.08 to .99, P < .05]). There was no significant change in CLABSIs in the control ICU. CONCLUSIONS: Implementation of the IHI Central Line Bundle reduced the incidence of CLABSIs in our SICU by 68%, preventing 12 CLABSIs, 2.5 deaths, and saving $198,600 annually. DA - 2014/// PY - 2014 VL - 207 IS - 6 SP - 817 EP - 23 J2 - Am J Surg LA - eng SN - 1879-1883 (Electronic) UR - https://pubmed.ncbi.nlm.nih.gov/24576582/ AN - 24576582 Y2 - 0006/01/02/ N1 -RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Humans KW - Adult KW - Female KW - Male KW - Incidence KW - Prospective Studies KW - Intensive Care Units KW - Checklist KW - Case-Control Studies KW - *Quality Improvement KW - APACHE KW - Intensive Care Units/economics/*organization & administration KW - Catheter-Related Infections/economics/epidemiology/*prevention & control KW - Catheterization, Central Venous/*adverse effects/*standards KW - Health Care Costs KW - Infection Control/economics/*organization & administration KW - Los Angeles/epidemiology KW - Patient Care Bundles/economics/*standards ER - TY - JOUR TI - Empiric antibiotic, mechanical ventilation, and central venous catheter duration as potential factors mediating the effect of a checklist prompting intervention on mortality: an exploratory analysis. AU - Weiss CH AU - Persell SD AU - Wunderink RG AU - Baker DW T2 - BMC health services research AB - BACKGROUND: Checklists are clinical decision support tools that improve process of care and patient outcomes. We previously demonstrated that prompting critical care physicians to address issues on a daily rounding checklist that were being overlooked reduced utilization of empiric antibiotics and mechanical ventilation, and reduced risk-adjusted mortality and length of stay. We sought to examine the degree to which these process of care improvements explained the observed difference in hospital mortality between the group that received prompting and an unprompted control group. METHODS: In the medical intensive care unit (MICU) of a tertiary care hospital, we conducted face-to-face prompting of critical care physicians if processes of care on a checklist were being overlooked. A control MICU team used the checklist without prompting. We performed exploratory analyses of the mediating effect of empiric antibiotic, mechanical ventilation, and central venous catheter (CVC)duration on risk-adjusted mortality. RESULTS: One hundred forty prompted group and 125 control group patients were included. One hundred eighty-three patients were exposed to at least one day of empiric antibiotics during MICU admission. Hospital mortality increased as empiric antibiotic duration increased (P<0.001). Prompting was associated with shorter empiric antibiotic duration and lower risk-adjusted mortality in patients receiving empiric antibiotics (OR 0.41, 95% CI 0.18-0.92, P=0.032). When empiric antibiotic duration was added to mortality models, the adjusted OR for the intervention was attenuated from 0.41 to 0.50, suggesting that shorter duration of empiric antibiotics explained 15.2% of the overall benefit of prompting. Evaluation of mechanical ventilation was limited by study size. Accounting for CVC duration changed the intervention effect slightly. CONCLUSIONS: In this analysis, some improvement in mortality associated with prompting was explained by shorter empiric antibiotic duration. However, most of the mortality benefit of prompting was unexplained. DA - 2012/// PY - 2012 VL - 12 SP - 198 J2 - BMC Health Serv Res LA - eng SN - 1472-6963 (Electronic) UR - https://pubmed.ncbi.nlm.nih.gov/22794349/ AN - 22794349 Y2 - 0007/01/02/ N1 -RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Humans KW - Adult KW - Female KW - Male KW - Aged KW - Middle Aged KW - Length of Stay KW - *Checklist KW - Patient Care Team KW - Respiration, Artificial KW - Ventilators, Mechanical KW - APACHE KW - Time Factors KW - Anti-Bacterial Agents KW - Interdisciplinary Communication KW - *Respiration, Artificial KW - *Catheterization, Central Venous/adverse effects KW - *Hospital Mortality KW - Anti-Bacterial Agents/*therapeutic use KW - Decision Support Techniques KW - Hospitals, Urban KW - Intensive Care Units/*statistics & numerical data KW - Outcome and Process Assessment, Health Care/methods/*standards KW - Teaching Rounds KW - Utilization Review ER - TY - JOUR TI - Impact of enhanced ventilator care bundle checklist on nursing documentation in an intensive care unit. AU - Malouf-Todaro N AU - Barker J AU - Jupiter D AU - Tipton PH AU - Peace J T2 - Journal of nursing care quality AB - Ventilator-associated pneumonia is a hospital-acquired infection that may develop in patients 48 hours after mechanical ventilation. The project goal was to determine whether a ventilator-associated pneumonia care bundle checklist embedded into an existing electronic health record would increase completeness of nursing documentation in an intensive care unit setting. With the embedded checklist, there were significant improvements in nursing documentation and a decreased incidence of ventilator-associated pneumonia. DA - 2013/// PY - 2013 VL - 28 IS - 3 SP - 233 EP - 40 J2 - J Nurs Care Qual LA - eng SN - 1550-5065 (Electronic) UR - https://pubmed.ncbi.nlm.nih.gov/23291742/ AN - 23291742 Y2 - 0007/01/02/ N1 -RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Humans KW - Retrospective Studies KW - Incidence KW - Ventilators, Mechanical KW - Documentation KW - Program Evaluation KW - Checklist/*methods KW - Respiration, Artificial/*nursing KW - Critical Care Nursing/*methods/organization & administration KW - Intensive Care Units/organization & administration KW - Nursing Records KW - Pneumonia, Ventilator-Associated/epidemiology/*nursing/*prevention & control ER - TY - JOUR TI - Rebound in ventilator-associated pneumonia rates during a prevention checklist washout period. AU - Cheema AA AU - Scott AM AU - Shambaugh KJ AU - Shaffer-Hartman JN AU - Dechert RE AU - Hieber SM AU - Gosbee JW AU - Niedner MF T2 - BMJ quality & safety AB - OBJECTIVE To describe the washout effect after stopping a prevention checklist for ventilator-associated pneumonia (VAP). METHODS VAP rates were prospectively monitored for special cause variation over 42 months in a paediatric intensive care unit. A VAP prevention bundle was implemented, consisting of head of bed elevation, oral care, suctioning device management, ventilator tubing care, and standard infection control precautions. Key practices of the bundle were implemented with a checklist and subsequently incorporated into the nursing and respiratory care bedside flow sheets to achieve long-term sustainability. Compliance with the VAP bundle was monitored throughout. The timeline for the project was retrospectively categorised into the benchmark phase, the checklist phase (implementation), the checklist washout phase, and the flowsheet phase (cues in the flowsheet). RESULTS During the checklist phase (12 months), VAP bundle compliance rose from <50% to >75% and the VAP rate fell from 4.2 to 0.7 infections per 1000 ventilator days (p<0.059). Unsolicited qualitative feedback from frontline staff described overburdensome documentation requirements, form fatigue, and checklist burnout. During the checklist washout phase (4 months), VAP rates rose to 4.8 infections per 1000 ventilator days (p<0.042). In the flowsheet phase, the VAP rate dropped to 0.8 infections per 1000 ventilator days (p<0.047). CONCLUSIONS Salient cues to drive provider behaviour towards best practice are helpful to sustain process improvement, and cessation of such cues should be approached warily. Initial education, year-long habit formation, and effective early implementation demonstrated no appreciable effect on the VAP rate during the checklist washout period. DA - 2011/// PY - 2011 VL - 20 IS - 9 SP - 811 EP - 7 J2 - BMJ Qual Saf LA - eng SN - 2044-5423 (Electronic) UR - https://pubmed.ncbi.nlm.nih.gov/21685186/ AN - 21685186 Y2 - 0009/01/02/ N1 -RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Humans KW - Prospective Studies KW - *Checklist KW - Ventilators, Mechanical KW - Program Evaluation KW - Guideline Adherence KW - Pneumonia, Ventilator-Associated/*prevention & control KW - *Diffusion of Innovation KW - Intensive Care Units, Pediatric KW - Pneumonia KW - Quality Assurance, Health Care/organization & administration ER - TY - JOUR TI - Electronic trauma patient outcomes assessment tool: performance improvement in the trauma intensive care unit. AU - Salazar A AU - Tyroch AH AU - Smead DG T2 - Journal of trauma nursing : the official journal of the Society of Trauma Nurses AB - An electronic dashboard can enhance compliance with a specific checklist of indicators with daily management of injured patients in a trauma intensive care unit effectively. A performance management electronic dashboard monitored 24 indicators in the trauma intensive care unit over a 3-year period. Over a 3-year period, utilization of the electronic dashboard improved from 64% to 100% and mean compliance rose from 94.8% to 97.4%. Implementation of an electronic dashboard enhances compliance in managing trauma patients in a sustainable manner, allows immediate correction of deficiencies, monitors trends, and facilitates performance improvement/patient safety initiatives of a trauma program. DA - 2011/// PY - 2011 VL - 18 IS - 4 SP - 197 EP - 201 J2 - J Trauma Nurs LA - eng SN - 1078-7496 (Print) UR - https://pubmed.ncbi.nlm.nih.gov/22157526/ AN - 22157526 Y2 - 0010/01/02/ N1 -RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Humans KW - Female KW - Male KW - *Checklist KW - Quality Improvement KW - Critical Care/*standards KW - Intensive Care Units/*organization & administration KW - United States KW - Health Care Surveys KW - Electronic Data Processing/standards KW - Outcome Assessment, Health Care/*methods KW - Professional Competence KW - Trauma Centers/organization & administration KW - Wounds and Injuries/*nursing ER - TY - JOUR TI - Central line insertion bundle: experiences and challenges in an adult ICU. AU - McPeake J AU - Cantwell S AU - Booth MG AU - Daniel M T2 - Nursing in critical care AB - BACKGROUND: Central venous catheters are used frequently in the intensive care unit (ICU). However, there is an associated morbidity, mortality and cost derived from their infectious and mechanical complications. The Scottish Patient Safety Programme (SPSP) has developed a multi faceted care bundle, with the aim of reducing catheter-related blood stream infections. AIM: This paper aims to identify and describe the experience and challenges in implementing the SPSP central line insertion bundle in one adult ICU, in a large inner city teaching hospital. INTERVENTIONS: 'Plan-Do-Study-Act' cycles, checklists for insertion and a standardized trolley were adopted to implement the central line insertion bundle in clinical practice. CONCLUSION/IMPLICATIONS: Improving the reliability of the central line insertion bundle has reduced infections. Key steps in the process were setting clear aims and ensuring staff understand the change process and measurement of results. This is fundamental to the success of any quality improvement process. DA - 2012/// PY - 2012 VL - 17 IS - 3 SP - 123 EP - 9 J2 - Nurs Crit Care LA - eng SN - 1478-5153 (Electronic) UR - https://pubmed.ncbi.nlm.nih.gov/22497916/ AN - 22497916 Y2 - 0005/01/02/ N1 -RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Humans KW - Adult KW - Patient Safety/*standards KW - Reproducibility of Results KW - Critical Care/*methods KW - Interprofessional Relations KW - Outcome and Process Assessment, Health Care/methods KW - Hospitals, Urban KW - *Program Development KW - Bacteremia/etiology/prevention & control KW - Catheter-Related Infections/microbiology/prevention & control KW - Catheterization, Central Venous/adverse effects/*methods/standards KW - Checklist/*statistics & numerical data KW - Disinfection/methods KW - Documentation/methods KW - Efficiency, Organizational KW - Evidence-Based Medicine KW - Preoperative Care/methods KW - Protective Devices KW - Quality Improvement/*standards KW - Scotland ER - TY - JOUR TI - Checklists for Safety During ICU Intubations: The Details Matter. AU - Doerschug KC AU - Niven AS T2 - Chest DA - 2018/// PY - 2018 VL - 153 IS - 6 SP - 1505 EP - 1506 J2 - Chest LA - eng SN - 1931-3543 (Electronic) UR - https://pubmed.ncbi.nlm.nih.gov/29884259/ AN - 29884259 Y2 - 0006/01/02/ N1 -RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Humans KW - Adult KW - Intensive Care Units KW - *Checklist KW - Intubation, Intratracheal KW - *Critical Illness ER - TY - JOUR TI - Measurable outcomes of quality improvement using a daily quality rounds checklist: one-year analysis in a trauma intensive care unit with sustained ventilator-associated pneumonia reduction. AU - Dubose J AU - Teixeira PG AU - Inaba K AU - Lam L AU - Talving P AU - Putty B AU - Plurad D AU - Green DJ AU - Demetriades D AU - Belzberg H T2 - The Journal of trauma AB - BACKGROUND: We have previously demonstrated that the use of a daily "Quality Rounds Checklist" (QRC) can increase compliance with evidence-based prophylactic measures and decrease complications in a busy trauma intensive care unit (ICU) over a 3-month period. This study was designed to determine the sustainability of QRC use over 1 year and examine the relationship between compliance and outcome improvement. METHODS: A prospective before-after design was used to examine the effectiveness of the QRC tool in documenting compliance with 16 prophylactic measures for ventilator-associated pneumonia (VAP), deep venous thrombosis, pulmonary embolism, catheter-related bloodstream infection, and other ICU complications. The QRC was implemented on a daily basis for a 1-year period by the ICU fellow on duty. Monthly compliance rates were assessed by a multidisciplinary team for development of strategies for real-time improvement. Compliance and outcomes were captured over 1 year of QRC use. RESULTS: QRC use was associated with a sustained improvement of VAP bundle and other compliance measures over a year of use. After multivariable analysis adjusting for age (> 55), injury mechanism, Glasgow Coma Scale score (≤ 8), and Injury Severity Score (> 20), the rate of VAP was significantly lower after QRC use, with an adjusted mean difference of -6.65 (per 1,000 device days; 95% confidence interval, -9.27 to -4.04; p = 0.008). During the year of QRC use, 3% of patients developed a VAP if all four daily bundle measures were met for the duration of ICU stay versus 14% in those with partial compliance (p = 0.04). The overall VAP rate with full compliance was 5.29 versus 9.23 (per 1,000 device days) with partial compliance. Compared with the previous year, a 24% decrease in the number of pneumonias was recorded for the year of QRC use, representing an estimated cost savings of approximately $400,000. CONCLUSION: The use of a QRC facilitates sustainable improvement in compliance rates for clinically significant prophylactic measures in a busy Level I trauma ICU. The daily use of the QRC, requiring just a few minutes per patient to complete, equates to cost-effective improvement in patient outcomes. DA - 2010/// PY - 2010 VL - 69 IS - 4 SP - 855 EP - 60 J2 - J Trauma LA - eng SN - 1529-8809 (Electronic) UR - https://pubmed.ncbi.nlm.nih.gov/20032792/ AN - 20032792 Y2 - 0010/01/02/ N1 -RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Humans KW - Adult KW - Female KW - Male KW - Aged KW - Middle Aged KW - Prospective Studies KW - Adolescent KW - Intensive Care Units/*standards KW - Academic Medical Centers KW - *Checklist KW - Hospital Mortality KW - Young Adult KW - California KW - Outcome Assessment (Health Care) KW - Pneumonia KW - Cross Infection/mortality/prevention & control KW - Evidence-Based Medicine/*standards KW - Guideline Adherence/standards KW - Pneumonia, Ventilator-Associated/*mortality/*prevention & control KW - Quality Assurance, Health Care/standards KW - Quality Indicators, Health Care/*standards KW - Wounds and Injuries/*mortality/therapy ER - TY - JOUR TI - Using a checklist to identify barriers to compliance with evidence-based guidelines for central line management: a mixed methods study in Mongolia. AU - Ider BE AU - Adams J AU - Morton A AU - Whitby M AU - Muugolog T AU - Lundeg G AU - Clements A T2 - International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases AB - OBJECTIVES: This study aimed to determine the extent to which a checklist has potential for identifying barriers to compliance with central line management guidelines, to evaluate the potential utility of checklists to improve the management of central lines in Mongolia, and to define the gap between current and best practices. METHODS: A 22-item checklist was developed based on the Centers for Disease Control and Prevention (CDC, USA) guidelines and existing central line-associated bloodstream infection (CLABSI) checklists. The checklist was used to observe 375 central line procedures performed in the intensive care units of four tertiary hospitals of Mongolia between July and December 2010. In parallel, 36 face-to-face interviews were conducted in six other tertiary hospitals to explain practice variations and identify barriers. RESULTS: The baseline compliance level across all components of the checklist was 68.5%. The main factors explaining low levels of compliance were outdated local standards, a lack of updated guidelines, poor control over compliance with existing clinical guidelines, poor supply of medical consumables, and insufficient knowledge of contemporary infection control measures among health care providers. CONCLUSIONS: The health authorities of Mongolia need to adequately address the prevention and control of CLABSIs in their hospitals. Updating local standards and guidelines and implementing adequate multifaceted interventions with behavioral, educational, and logistical components are required. Use of a checklist as a baseline evaluation tool was feasible. It described current practice, showed areas that need urgent attention, and provided important information needed for future planning of CLABSI interventions. DA - 2012/// PY - 2012 VL - 16 IS - 7 SP - e551 EP - 7 J2 - Int J Infect Dis LA - eng SN - 1878-3511 (Electronic) UR - https://pubmed.ncbi.nlm.nih.gov/22608032/ AN - 22608032 Y2 - 0007/01/02/ N1 -RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Humans KW - Adult KW - Female KW - Male KW - Middle Aged KW - Adolescent KW - Child KW - Child, Preschool KW - Infant KW - *Checklist KW - *Guideline Adherence KW - *Practice Guidelines as Topic KW - Intensive Care Units/statistics & numerical data KW - Young Adult KW - Evidence-Based Medicine/*standards KW - Bacteremia/epidemiology/*prevention & control KW - Catheter-Related Infections/epidemiology/prevention & control KW - Catheterization, Central Venous/adverse effects/*standards KW - China KW - Hospitals/standards KW - Infant, Newborn KW - Infection Control/methods KW - Mongolia ER - TY - JOUR TI - Effectiveness of stepwise interventions targeted to decrease central catheter-associated bloodstream infections. AU - Munoz-Price LS AU - Dezfulian C AU - Wyckoff M AU - Lenchus JD AU - Rosalsky M AU - Birnbach DJ AU - Arheart KL T2 - Critical care medicine AB - OBJECTIVE: Determine the impact of three stepwise interventions on the rate of central catheter-associated bloodstream infections. DESIGN: Quasi-experimental study. SETTING: Three surgical intensive care units (general surgery, trauma, and neurosurgery) at a 1500-bed county teaching hospital in the Miami metro area. PATIENTS: All consecutive central catheter-associated bloodstream infection cases as determined by the Infection Control Department. INTERVENTIONS: Three interventions aimed at catheter maintenance were implemented at different times in the units: chlorhexidine "scrub-the-hub," chlorhexidine daily baths, and daily nursing rounds aimed at assuring compliance with an intensive care unit goal-oriented checklist. MEASUREMENTS AND MAIN RESULTS: The primary outcome was the monthly intensive care unit rate of central catheter-associated bloodstream infections (infections per 1000 central catheter days). Over 33 months of follow-up (July 2008 to March 2011), we found decreased rates in each of the three intensive care units evaluated during the interventions, especially after implementation of chlorhexidine daily baths. Rates in unit A decreased from a rate of 8.6 to 0.5, unit B from 6.9 to 1.6, and unit C from 7.8 to 0.6. Secondary bloodstream infection rates remained unchanged throughout the observation period in units A and B; however, unit C had a decrease in its rates over time. CONCLUSIONS: We report the progressive reduction of central catheter-associated bloodstream infection rates after the stepwise implementation of chlorhexidine "scrub-the-hub" and daily baths in surgical intensive care units, suggesting effectiveness of these interventions. DA - 2012/// PY - 2012 VL - 40 IS - 5 SP - 1464 EP - 9 J2 - Crit Care Med LA - eng SN - 1530-0293 (Electronic) UR - https://pubmed.ncbi.nlm.nih.gov/22511128/ AN - 22511128 Y2 - 0005/01/02/ N1 -RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Humans KW - Intensive Care Units KW - Checklist KW - Catheter-Related Infections/epidemiology/microbiology/nursing/*prevention & control KW - Catheterization, Central Venous/*adverse effects/methods/nursing KW - Chlorhexidine/therapeutic use KW - Cross Infection/epidemiology/microbiology/nursing/*prevention & control KW - Disinfectants/therapeutic use ER - TY - JOUR TI - [Daily evaluation of the FASTHUG protocol and short-term outcomes]. AU - Curiel Balsera E AU - Joya Montosa C AU - Trujillo García E AU - Martinez Gonzalez MC AU - Molina Diaz H T2 - Medicina intensiva DA - 2014/// PY - 2014 VL - 38 IS - 6 SP - 393 EP - 4 J2 - Med Intensiva LA - spa SN - 1578-6749 (Electronic) UR - https://pubmed.ncbi.nlm.nih.gov/24199990/ AN - 24199990 Y2 - 0008/01/02/ N1 -RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Humans KW - Female KW - Male KW - Treatment Outcome KW - *Checklist KW - Critical Care/*standards KW - Clinical Protocols KW - Time Factors ER - TY - JOUR TI - Daily goals: not just another piece of paper*. AU - Rawat N AU - Berenholtz S T2 - Critical care medicine DA - 2014/// PY - 2014 VL - 42 IS - 8 SP - 1940 EP - 1 J2 - Crit Care Med LA - eng SN - 1530-0293 (Electronic) UR - https://pubmed.ncbi.nlm.nih.gov/25029132/ AN - 25029132 Y2 - 0008/01/02/ N1 -RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Humans KW - *Checklist KW - Intensive Care Units/*organization & administration KW - Critical Care/*methods KW - *Attitude of Health Personnel KW - Physicians/*psychology KW - Students, Medical/*psychology KW - Teaching Rounds/*organization & administration ER - TY - JOUR TI - A clinical trial comparing physician prompting with an unprompted automated electronic checklist to reduce empirical antibiotic utilization. AU - Weiss CH AU - Dibardino D AU - Rho J AU - Sung N AU - Collander B AU - Wunderink RG T2 - Critical care medicine AB - OBJECTIVES: To determine whether face-to-face prompting of critical care physicians reduces empirical antibiotic utilization compared to an unprompted electronic checklist embedded within the electronic health record. DESIGN: Random allocation design. SETTING: Medical ICU with high-intensity intensivist coverage at a tertiary care urban medical center. PATIENTS: Two hundred ninety-six critically ill patients treated with at least 1 day of empirical antibiotics. INTERVENTIONS: For one medical ICU team, face-to-face prompting of critical care physicians if they did not address empirical antibiotic utilization during a patient's daily rounds. On a separate medical ICU team, attendings and fellows were trained once to complete an electronic health record-embedded checklist daily for each patient, including a question asking whether listed empirical antibiotics could be discontinued. MEASUREMENTS AND MAIN RESULTS: Prompting led to a more than four-fold increase in discontinuing or narrowing of empirical antibiotics compared to use of the electronic checklist. Prompted group patients had a lower proportion of patient-days on which empirical antibiotics were administered compared to electronic checklist group patients (63.1% vs 70.0%, p = 0.002). Mean proportion of antibiotic-days on which empirical antibiotics were used was also lower in the prompted group, although not statistically significant (0.78 [0.27] vs 0.83 [0.27], p = 0.093). Each additional day of empirical antibiotics predicted higher risk-adjusted mortality (odds ratio, 1.14; 95% CI, 1.05-1.23). Risk-adjusted ICU length of stay and hospital mortality were not significantly different between the two groups. CONCLUSIONS: Face-to-face prompting was superior to an unprompted electronic health record-based checklist at reducing empirical antibiotic utilization. Sustained culture change may have contributed to the electronic checklist having similar empirical antibiotic utilization to a prompted group in the same medical ICU 2 years prior. Future studies should investigate the integration of an automated prompting mechanism with a more generalizable electronic health record-based checklist. DA - 2013/// PY - 2013 VL - 41 IS - 11 SP - 2563 EP - 9 J2 - Crit Care Med LA - eng SN - 1530-0293 (Electronic) UR - https://pubmed.ncbi.nlm.nih.gov/23939354/ AN - 23939354 Y2 - 0011/01/02/ N1 -RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Humans KW - Adult KW - Female KW - Male KW - Aged KW - Middle Aged KW - *Checklist KW - Aged, 80 and over KW - Critical Care/*methods KW - Anti-Bacterial Agents KW - Anti-Bacterial Agents/*administration & dosage KW - Drug Utilization/*statistics & numerical data KW - *Electronic Health Records KW - Practice Patterns, Physicians'/statistics & numerical data KW - Tertiary Care Centers/statistics & numerical data ER - TY - JOUR TI - Preventing patient harms through systems of care. AU - Pronovost PJ AU - Bo-Linn GW T2 - JAMA DA - 2012/// PY - 2012 VL - 308 IS - 8 SP - 769 EP - 70 J2 - JAMA LA - eng SN - 1538-3598 (Electronic) UR - https://pubmed.ncbi.nlm.nih.gov/22910751/ AN - 22910751 Y2 - 0008/01/02/ N1 -RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Humans KW - Intensive Care Units/standards KW - *Checklist KW - United States KW - *Patient Safety KW - *Harm Reduction KW - *Systems Integration KW - Patient Care/*standards KW - Risk ER - TY - JOUR TI - Checklist use in ICUs: a French national survey. AU - Fischer MO AU - Mahjoub Y AU - Ayissi DA AU - Boisselier C AU - Guinot PG AU - Lorne E AU - Dupont H AU - Gérard JL AU - Hanouz JL T2 - Intensive care medicine DA - 2015/// PY - 2015 VL - 41 IS - 6 SP - 1149 EP - 50 J2 - Intensive Care Med LA - eng SN - 1432-1238 (Electronic) UR - https://pubmed.ncbi.nlm.nih.gov/25851393/ AN - 25851393 Y2 - 0006/01/02/ N1 -RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Intensive Care Units/*standards KW - *Checklist KW - Critical Care/*methods KW - France ER - TY - JOUR TI - Championing change by 'ticking boxes'. AU - Melia R T2 - Nursing standard (Royal College of Nursing (Great Britain) : 1987) DA - 2013/// PY - 2013 VL - 28 IS - 2 SP - 64 J2 - Nurs Stand LA - eng SN - 0029-6570 (Print) UR - https://pubmed.ncbi.nlm.nih.gov/24020583/ AN - 24020583 Y2 - 0009/01/02/ N1 -RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Humans KW - Ticks KW - *Checklist KW - *Intensive Care Units KW - *Quality Improvement KW - Documentation KW - *Patient Admission KW - England KW - Task Performance and Analysis ER - TY - JOUR TI - A checklist for a central venous line-based simulation scenario to measure behavioral compliance with Joint Commission National Patient Safety Goals. AU - Pernar LI AU - Shaw TJ AU - Pozner CN AU - Vogelgesang KR AU - Peyre SE T2 - Simulation in healthcare : journal of the Society for Simulation in Healthcare DA - 2011/// PY - 2011 VL - 6 IS - 2 SP - 117 EP - 20 J2 - Simul Healthc LA - eng SN - 1559-713X (Electronic) UR - https://pubmed.ncbi.nlm.nih.gov/21487348/ AN - 21487348 Y2 - 0004/01/02/ N1 -RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Humans KW - Male KW - Aged KW - Intensive Care Units KW - *Checklist KW - *Guideline Adherence KW - United States KW - Clinical Competence KW - *Manikins KW - Goals KW - Health Knowledge, Attitudes, Practice KW - Catheterization, Central Venous/*methods KW - Joint Commission on Accreditation of Healthcare Organizations KW - Medical Errors/*prevention & control KW - Safety/*standards KW - Teaching ER - TY - NEWS TI - Long-term elimination of ICU infections requires specific steps. AU - Traynor K T2 - American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists CY - England DA - 2011/// PY - 2011 SP - 1765 EP - 6 LA - eng SN - 1535-2900 (Electronic) UR - https://pubmed.ncbi.nlm.nih.gov/21930627/ AN - 21930627 Y2 - 0010/01/02/ N1 -RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Humans KW - Checklist KW - Cross Infection/*prevention & control KW - Intensive Care Units/*organization & administration KW - Critical Care/*organization & administration KW - Guideline Adherence KW - Catheter-Related Infections/prevention & control KW - Pneumonia, Ventilator-Associated/prevention & control ER - TY - JOUR TI - Promoters and Barriers to Implementation of Tracheal Intubation Airway Safety Bundle: A Mixed-Method Analysis. AU - Davis, Katherine Finn AU - Napolitano, Natalie AU - Li, Simon AU - Buffman, Hayley AU - Rehder, Kyle AU - Pinto, Matthew AU - Nett, Sholeen AU - Jarvis, J Dean AU - Kamat, Pradip AU - Sanders, Ronald C AU - Turner, David A AU - Sullivan, Janice E AU - Bysani, Kris AU - Lee, Anthony AU - Parker, Margaret AU - Adu-Darko, Michelle AU - Giuliano, John AU - Biagas, Katherine AU - Nadkarni, Vinay AU - Nishisaki, Akira T2 - Pediatr Crit Care Med AB - OBJECTIVES: To describe promoters and barriers to implementation of an airway safety quality improvement bundle from the perspective of interdisciplinary frontline clinicians and ICU quality improvement leaders. DESIGN: Mixed methods. SETTING: Thirteen PICUs of the National Emergency Airway Registry for Children network. INTERVENTION: Remote or on-site focus groups with interdisciplinary ICU staff. Two semistructured interviews with ICU quality improvement leaders with quantitative and qualitative data-based feedbacks. MEASUREMENTS AND MAIN RESULTS: Bundle implementation success (compliance) was defined as greater than or equal to 80% use for tracheal intubations for 3 consecutive months. ICUs were classified as early or late adopters. Focus group discussions concentrated on safety concerns and promoters and barriers to bundle implementation. Initial semistructured quality improvement leader interviews assessed implementation tactics and provided recommendations. Follow-up interviews assessed degree of acceptance and changes made after initial interview. Transcripts were thematically analyzed and contrasted by early versus late adopters. Median duration to achieve success was 502 days (interquartile range, 182-781). Five sites were early (median, 153 d; interquartile range, 146-267) and eight sites were late adopters (median, 783 d; interquartile range, 773-845). Focus groups identified common "promoter" themes-interdisciplinary approach, influential champions, and quality improvement bundle customization-and "barrier" themes-time constraints, competing paperwork and quality improvement activities, and poor engagement. Semistructured interviews with quality improvement leaders identified effective and ineffective tactics implemented by early and late adopters. Effective tactics included interdisciplinary quality improvement team involvement (early adopter: 5/5, 100% vs late adopter: 3/8, 38%; p = 0.08); ineffective tactics included physician-only rollouts, lack of interdisciplinary education, lack of data feedback to frontline clinicians, and misconception of bundle as research instead of quality improvement intervention. CONCLUSIONS: Implementation of an airway safety quality improvement bundle with high compliance takes a long time across diverse ICUs. Both early and late adopters identified similar promoter and barrier themes. Early adopter sites customized the quality improvement bundle and had an interdisciplinary quality improvement team approach. DA - 2017/// PY - 2017 VL - 18 IS - 10 SP - 965 EP - 972 LA - en UR - https://dx.doi.org/10.1097/PCC.0000000000001251 AN - rayyan-105241327 N1 -RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Actitud del Personal de Salud KW - Adulto KW - Cuidados Críticos/métodos KW - Cuidados Críticos/normas KW - Entrevistas como Asunto KW - Estudios de Seguimiento KW - Estudios Prospectivos KW - Femenino KW - Grupos Focales KW - Humanos KW - Intubación Intratraqueal/métodos KW - Intubación Intratraqueal/normas KW - Investigación Cualitativa KW - Lista de Verificación KW - Masculino KW - Mejoramiento de la Calidad KW - Niño KW - Paquetes de Atención al Paciente KW - Persona de Mediana Edad KW - Seguridad del Paciente KW - Sistema de Registros KW - Unidades de Cuidado Intensivo Pediátrico/normas ER - TY - JOUR TI - Barriers and facilitators to improve safety and efficiency of the ICU discharge process: a mixed methods study. AU - van Sluisveld, Nelleke AU - Oerlemans, Anke AU - Westert, Gert AU - van der Hoeven, Johannes Gerardus AU - Wollersheim, Hub AU - Zegers, Marieke T2 - BMC Health Serv Res AB - BACKGROUND: Evidence indicates that suboptimal clinical handover from the intensive care unit (ICU) to general wards leads to unnecessary ICU readmissions and increased mortality. We aimed to gain insight into barriers and facilitators to implement and use ICU discharge practices. METHODS: A mixed methods approach was conducted, using 1) 23 individual and four focus group interviews, with post-ICU patients, ICU managers, and nurses and physicians working in the ICU or general ward of ten Dutch hospitals, and 2) a questionnaire survey, which contained 27 statements derived from the interviews, and was completed by 166 ICU physicians (21.8%) from 64 Dutch hospitals (71.1% of the total of 90 Dutch hospitals). RESULTS: The interviews resulted in 66 barriers and facilitators related to: the intervention (e.g., feasibility); the professional (e.g., attitude towards checklists); social factors (e.g., presence or absence of a culture of feedback); and the organisation (e.g., financial resources). A facilitator considered important by ICU physicians was a checklist to structure discharge communication (92.2%). Barriers deemed important were lack of a culture of feedback (55.4%), an absence of discharge criteria (23.5%), and an overestimation of the capabilities of general wards to care for complex patients by ICU physicians (74.7%). CONCLUSIONS: Based on the barriers and facilitators found in this study, improving handover communication, formulating specific discharge criteria, stimulating a culture of feedback, and preventing overestimation of the general ward are important to effectively improve the ICU discharge process. DA - 2017/// PY - 2017 VL - 17 IS - 1 SP - 251 EP - 251 LA - en UR - https://dx.doi.org/10.1186/s12913-017-2139-x AN - rayyan-105241328 N1 -RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Adulto KW - Cuidados Críticos/métodos KW - Entrevistas como Asunto KW - Femenino KW - Grupos Focales KW - Humanos KW - Investigación Cualitativa KW - Lista de Verificación KW - Masculino KW - Mejoramiento de la Calidad KW - Persona de Mediana Edad KW - Alta del Paciente/normas KW - Encuestas y Cuestionarios KW - Habitaciones de Pacientes KW - Países Bajos KW - Pase de Guardia KW - Seguridad del Paciente/normas KW - Unidades de Cuidados Intensivos ER - TY - JOUR TI - Análisis aleatorios de seguridad en tiempo real, una herramienta transformadora adaptada a los nuevos tiempos. AU - Bodí, M AU - Oliva, I AU - Martín, M C AU - Sirgo, G T2 - Med Intensiva AB - Real-time random safety audits constitute a tool designed to transfer knowledge from the sources of scientific evidence to the patient bedside. It has proven useful in critically ill patients, improving safety in the process of critical patient care, turning unsafe situations into safe ones in daily practice, and ensuring adherence to scientific evidence. In parallel, the design and methodology involved affords process indicators that will make it possible to know how we provide care for our patients, evolution over time (with regular feedback for professionals), the impact of our interventions, and benchmarking. DA - 2017/// PY - 2017 VL - 41 IS - 6 SP - 368 EP - 376 LA - en UR - https://dx.doi.org/10.1016/j.medin.2016.09.006 AN - rayyan-105241329 N1 -RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Cuidados Críticos/normas KW - Humanos KW - Lista de Verificación KW - Seguridad del Paciente KW - Unidades de Cuidados Intensivos KW - amp KW - Auditoría Médica KW - control KW - Distribución Aleatoria KW - Errores Médicos/prevención & ER - TY - JOUR TI - Fast hug: um aliado na manutenção diária dos cuidados de enfermagem ao paciente crítico AU - Santos, Rebeca Ramos AU - Henrique, Danielle de Mendonça AU - Almeida, Luana Ferreira de AU - Penteado, Maridalva de Souza AU - Pereira, Sandra Regina Maciqueira AU - Santos, Dayanne Pamela da Silva T2 - Enferm. foco (Brasília) AB - Objetivo: compreender se enfermeiros consideram relevante a utilização do Fast Hug (FH) na assistência ao paciente crítico. Metodologia: estudo descritivo, de abordagem quanti-qualitativa, realizado em uma UTI de um Hospital Universitário do Rio de Janeiro. Resultados: das 17 enfermeiras participantes, 11 não conheciam o FH, 10 não haviam trabalhado em instituição que o utilize. O item profilaxia de trombose foi considerado o mais difícil de avaliar por 8 delas; a maioria (15) acreditou ser necessária sua implementação no setor, sendo sugeridas as seguintes estratégias: utilizá-lo na avaliação do paciente, passagem de plantão, checklist e visita multiprofissional. Conclusão: as enfermeiras demonstraram interesse em aplicar o FH, compreendendo sua relevância. DA - 2017/// PY - 2017 VL - 8 IS - 1 SP - 57 EP - 61 LA - pt UR - http://revista.portalcofen.gov.br/index.php/enfermagem/article/view/840/361 AN - rayyan-105241330 N1 -RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Femenino KW - Humanos KW - Lista de Verificación KW - Masculino KW - Seguridad del Paciente KW - Unidades de Cuidados Intensivos KW - Atención de Enfermería KW - Cuidados Críticos KW - Hospitales Universitarios ER - TY - JOUR TI - Checklist para passagem de plantão de pacientes em pós-operatório na admissão em terapia intensiva AU - Silva, Sabrina Guterres da AU - Nascimento, Eliane Regina Pereira do AU - Hermida, Patrícia Madalena Vieira AU - Sena, Adnairdes Cabral de AU - Klein, Taise Costa Ribeiro AU - Pinho, Fabiana Minati de T2 - Enferm. foco (Brasília) AB - Objetivo: conhecer a percepção dos profissionais de enfermagem sobre a passagem de plantão e construir um checklist para passagem de plantão de pacientes em pós-operatório imediato admitidos na Terapia Intensiva. Metodologia: estudo qualitativo, exploratório e descritivo, realizado em hospital público de Santa Catarina, com entrevista semiestruturada a 55 profissionais de Enfermagem da Terapia Intensiva e Centro Cirúrgico. Na análise, se utilizou o Discurso do Sujeito Coletivo. Resultados: os relatos originaram as ideias centrais: Relação entre a passagem de plantão e a segurança do paciente e Informações necessárias para sistematização da passagem de plantão. Conclusões: a passagem de plantão é percebida como essencial ao planejamento do cuidado seguro e o checklist contemplou informações acerca da identificação do paciente, das intercorrências no Centro Cirúrgico e dispositivos invasivos. A objetividade do checklist poderá facilitar sua implementação. DA - 2016/// PY - 2016 VL - 7 IS - 1 SP - 13 EP - 17 LA - pt UR - http://revista.portalcofen.gov.br/index.php/enfermagem/article/view/658/277 AN - rayyan-105241332 N1 -RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Femenino KW - Humanos KW - Lista de Verificación KW - Masculino KW - Unidades de Cuidados Intensivos KW - Cuidados Críticos KW - Centros Quirúrgicos KW - Enfermería KW - Prestación de Atención de Salud ER - TY - JOUR TI - The effect of a checklist on the quality of patient handover from the operating room to the intensive care unit: A randomized controlled trial. AU - Salzwedel, Cornelie AU - Mai, Victoria AU - Punke, Mark A AU - Kluge, Stefan AU - Reuter, Daniel A T2 - J Crit Care AB - PURPOSE: Handover of patient care is a potential safety risk for the patient due to loss of information which may result in adverse outcome. We hypothesized that a checklist for handover from the operating room (OR) to the intensive care unit (ICU) will lead to an increase of quality regarding information transfer compared with a nonstandardized handover procedure. MATERIALS AND METHODS: The study was conducted as a prospective, randomized trial in a university hospital. The quality of handovers with checklist was compared with handovers without checklist. Handovers were recorded by digital voice recorder and analyzed using an individual rating sheet for each patient. This enabled to discriminate between items that "must be handed over" (red items) and items that "should be handed over" (yellow items). RESULTS: A total of 121 patient handovers from OR to ICU were included. Significantly more red items were handed over in the study group compared with the control group (study group: median 87.1%, 25-27 percentile 77.1%-90.0%; control group: median 75.0%, 25-75 percentile 66.7%-88.6%; P < .01). CONCLUSIONS: This study gives first evidence that the use of a standardized checklist for patient handover from OR to ICU increases the quantity and quality of transmitted medical information. DA - 2016/// PY - 2016 VL - 32 SP - 170 EP - 4 LA - en UR - https://dx.doi.org/10.1016/j.jcrc.2015.12.016 AN - rayyan-105241333 N1 -RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Intensive Care Units KW - Cuidados Críticos/métodos KW - Estudios Prospectivos KW - Humanos KW - Lista de Verificación KW - Seguridad del Paciente/normas KW - Unidades de Cuidados Intensivos KW - Hospitales Universitarios KW - Continuidad de la Atención al Paciente/normas KW - Cuidados Posoperatorios/métodos KW - Cuidados Posoperatorios/normas KW - Pase de Guardia/normas ER - TY - JOUR TI - Nursing handover from ICU to cardiac ward: Standardised tools to reduce safety risks. AU - Graan, Sher Michael AU - Botti, Mari AU - Wood, Beverley AU - Redley, Bernice T2 - Aust Crit Care AB - BACKGROUND: Standardising handover processes and content, and using context-specific checklists are proposed as solutions to mitigate risks for preventable errors and patient harm associated with clinical handovers. OBJECTIVES: Adapt existing tools to standardise nursing handover from the intensive care unit (ICU) to the cardiac ward and assess patient safety risks before and after pilot implementation. METHODS: A three-stage, pre-post interrupted time-series design was used. Data were collected using naturalistic observations and audio-recording of 40 handovers and focus groups with 11 nurses. In Stage 1, examination of existing practice using observation of 20 handovers and a focus group interview provided baseline data. In Stage 2, existing tools for high-risk handovers were adapted to create tools specific to ICU-to-ward handovers. The adapted tools were introduced to staff using principles from evidence-based frameworks for practice change. In Stage 3, observation of 20 handovers and a focus group with five nurses were used to verify the design of tools to standardise handover by ICU nurses transferring care of cardiac surgical patients to ward nurses. RESULTS: Stage 1 data revealed variable and unsafe ICU-to-ward handover practices: incomplete ward preparation; failure to check patient identity; handover located away from patients; and information gaps. Analyses informed adaptation of process, content and checklist tools to standardise handover in Stage 2. Compared with baseline data, Stage 3 observations revealed nurses used the tools consistently, ward readiness to receive patients (10% vs 95%), checking patient identity (0% vs 100%), delivery of handover at the bedside (25% vs 100%) and communication of complete information (40% vs 100%) improved. CONCLUSION: Clinician adoption of tools to standardise ICU-to-ward handover of cardiac surgical patients reduced handover variability and patient safety risks. The study outcomes provide context-specific tools to guide handover processes and delivery of verbal content, a safety checklist, and a risk recognition matrix. DA - 2016/// PY - 2016 VL - 29 IS - 3 SP - 165 EP - 71 LA - en UR - https://dx.doi.org/10.1016/j.aucc.2015.09.002 AN - rayyan-105241334 N1 -RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Femenino KW - Grupos Focales KW - Humanos KW - Lista de Verificación KW - Masculino KW - Persona de Mediana Edad KW - Seguridad del Paciente KW - amp KW - control KW - Errores Médicos/prevención & KW - Pase de Guardia/normas KW - Análisis de Series de Tiempo Interrumpido KW - Enfermería Cardiovascular KW - Enfermería de Cuidados Críticos ER - TY - JOUR TI - Guidelines for the prevention of ventilator-associated pneumonia and their implementation. The Spanish Zero-VAP bundle AU - Álvarez Lerma, F AU - Sánchez García, M AU - Lorente, L AU - Gordo, F AU - Añón, J. M AU - Álvarez, J AU - Palomar, M AU - García, R AU - Arias, S AU - Vázquez-Calatayud, M AU - Jam, R T2 - Med. intensiva (Madr., Ed. impr.) AB - BACKGROUND: ''Zero-VAP'' is a proposal for the implementation of a simultaneous multimodal intervention in Spanish intensive care units (ICU) consisting of a bundle of ventilator-associated pneumonia (VAP) prevention measures. Methods/DESIGN: An initiative of the Spanish Societies of Intensive Care Medicine and of Intensive Care Nurses, the project is supported by the Spanish Ministry of Health, and participation is voluntary. In addition to guidelines for VAP prevention, the ''Zero-VAP'' Project incorporates an integral patient safety program and continuous online validation of the application of the bundle. For the latter, VAP episodes and participation indices are entered into the web-based Spanish ICU Infection Surveillance Program ''ENVIN-HELICS'' database, which provides continuous information about local, regional and national VAP incidence rates. Implementation of the guidelines aims at the reduction of VAP to less than 9 episodes per 1000 days of mechanical ventilation. A total of 35 preventive measures were initially selected. A task force of experts used the Grading of Recommendations, Assessment, Development and Evaluation Working Group methodology to generate a list of 7 basic "mandatory" recommendations (education and training in airway management, strict hand hygiene for airway management, cuff pressure control, oral hygiene with chlorhexidine, semi-recumbent positioning, promoting measures that safely avoid or reduce time on ventilator, and discouraging scheduled changes of ventilator circuits, humidifiers and endotracheal tubes) and 3 additional "highly recommended" measures (selective decontamination of the digestive tract, aspiration of subglottic secretions, and a short course of IV antibiotic). Discussion: We present the Spanish VAP prevention guidelines and describe the methodology used for the selection and implementation of the recommendations and the organizational structure of the project. Compared to conventional guideline documents, the associated safety assurance program, the online data recording and compliance control systems, as well as the existence of a pre-defined objective are the distinct features of "Zero VAP" DA - 2014/// PY - 2014 VL - 38 IS - 4 SP - 226 EP - 236 LA - en UR - http://www.medintensiva.org/es-guidelines-for-prevention-ventilator-associated-pneumonia-articulo-S0210569114000126 AN - rayyan-105241341 N1 -RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Ventilators, Mechanical KW - Pneumonia KW - Cuidados Críticos/métodos KW - Humanos KW - Seguridad del Paciente KW - Unidades de Cuidados Intensivos KW - amp KW - control KW - Factores de Riesgo KW - Neumonía Asociada al Ventilador/prevención & KW - Respiración Artificial/métodos ER - TY - JOUR TI - What's new for patient safety in the ICU? AU - Garrouste-Orgeas, Maité AU - Valentin, Andreas T2 - Intensive Care Med DA - 2013/// PY - 2013 VL - 39 IS - 10 SP - 1829 EP - 31 LA - en UR - https://dx.doi.org/10.1007/s00134-013-3013-x AN - rayyan-105241347 N1 -RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Cuidados Críticos/métodos KW - Cuidados Críticos/normas KW - Humanos KW - Lista de Verificación KW - Seguridad del Paciente KW - amp KW - control KW - Errores Médicos/prevención & KW - administración KW - Comunicación Interdisciplinaria KW - Cuidados Críticos/organización & KW - Cultura Organizacional KW - Errores Médicos/tendencias KW - Grupo de Atención al Paciente/normas KW - Grupo de Atención al Paciente/organización & KW - Grupo de Atención al Paciente/tendencias KW - Unidades de Cuidados Intensivos/normas KW - Unidades de Cuidados Intensivos/organización & KW - Unidades de Cuidados Intensivos/tendencias ER - TY - JOUR TI - Patientensicherheit in der Anästhesie und Intensivmedizin. Massnahmen zur Verbesserung. AU - Rosenthal, C AU - Balzer, F AU - Boemke, W AU - Spies, C T2 - Med Klin Intensivmed Notfmed AB - Technical improvements as well as various strategies for error detection and error prevention have made intensive care medicine and anesthesiology a safe medical specialty. Due to the introduction of "Patient safety in the ICU: the Vienna declaration" of the European Society of Intensive Care Medicine (ESICM) from October 2009 and the "Helsinki declaration on patient safety" of the European Society of Anaesthesiology (ESA) and the European Board of Anaesthesiology (EBA) from June 2010, there are now specific recommendations for all hospitals in Europe concerning the safety measures that are considered to be of essential importance. Many of today's well-known safety strategies have been originally developed in non-medical environments, as for instance civil aviation. Such high reliability organizations may serve as examples in the medical domain. Critical incident reporting systems, crisis resource management and checklists, e.g. the World Health Organization (WHO) checklist, are safety approaches of this kind. In addition to these, standardized drug labelling, hand disinfection, techniques for patient handover and simulation-based training have been exemplarily selected for this article as measures that can increase patient safety. DA - 2013/// PY - 2013 VL - 108 IS - 8 SP - 657 EP - 65 LA - de UR - https://dx.doi.org/10.1007/s00063-012-0182-2 AN - rayyan-105241349 N1 -RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Humanos KW - Lista de Verificación KW - Mejoramiento de la Calidad KW - Seguridad del Paciente KW - amp KW - control KW - Errores Médicos/prevención & KW - Cuidados Críticos KW - Adhesión a Directriz KW - Alemania KW - Anestesiología KW - Medición de Riesgo ER - TY - JOUR TI - Streamlining the medication process improves safety in the intensive care unit. AU - Benoit, E AU - Eckert, P AU - Theytaz, C AU - Joris-Frasseren, M AU - Faouzi, M AU - Beney, J T2 - Acta Anaesthesiol Scand AB - BACKGROUND: Multiple interventions were made to optimize the medication process in our intensive care unit (ICU). 1 Transcriptions from the medical order form to the administration plan were eliminated by merging both into a single document; 2 the new form was built in a logical sequence and was highly structured to promote completeness and standardization of information; 3 frequently used drug names, approved units, and fixed routes were pre-printed; 4 physicians and nurses were trained with regard to the correct use of the new form. This study was aimed at evaluating the impact of these interventions on clinically significant types of medication errors. METHODS: Eight types of medication errors were measured by a prospective chart review before and after the interventions in the ICU of a public tertiary care hospital. We used an interrupted time-series design to control the secular trends. RESULTS: Over 85 days, 9298 lines of drug prescription and/or administration to 294 patients, corresponding to 754 patient-days were collected and analysed for the three series before and three series following the intervention. Global error rate decreased from 4.95 to 2.14% (-56.8%, P < 0.001). CONCLUSIONS: The safety of the medication process in our ICU was improved by simple and inexpensive interventions. In addition to the optimization of the prescription writing process, the documentation of intravenous preparation, and the scheduling of administration, the elimination of the transcription in combination with the training of users contributed to reducing errors and carried an interesting potential to increase safety. DA - 2012/// PY - 2012 VL - 56 IS - 8 SP - 966 EP - 75 LA - en UR - https://dx.doi.org/10.1111/j.1399-6576.2012.02707.x AN - rayyan-105241351 N1 -RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Intensive Care Units KW - Adulto KW - Cuidados Críticos/métodos KW - Femenino KW - Humanos KW - Masculino KW - Persona de Mediana Edad KW - Seguridad del Paciente KW - amp KW - control KW - administración KW - Cuidados Críticos/organización & KW - Unidades de Cuidados Intensivos/organización & KW - Anciano KW - Centros de Atención Terciaria KW - Control de Formularios y Registros KW - Documentación KW - dosificación KW - Enfermeras y Enfermeros KW - Errores de Medicación/prevención & KW - Modelos Logísticos KW - Preparaciones Farmacéuticas/administración & KW - Prescripciones de Medicamentos/normas KW - Sistemas de Medicación en Hospital/organización & KW - Suiza ER - TY - JOUR TI - Patient handovers within the hospital: translating knowledge from motor racing to healthcare. AU - Catchpole, Ken AU - Sellers, Richard AU - Goldman, Allan AU - McCulloch, Peter AU - Hignett, Sue T2 - Qual Saf Health Care AB - INTRODUCTION: This paper expands the analogy between motor racing team pit stops and patient handovers. Previous studies demonstrated how the handover of patients following surgery could be improved by learning from a motor racing team. This has been extended to include contributions from several motor racing teams, and by examining transfers at several different interfaces at a non-specialist UK teaching hospital. METHODS: Letters of invitation were sent to the technical managers of nine Formula 1 motor racing teams. Semistructured interviews were carried out at a UK teaching hospital with 10 clinical staff involved in the handover of patients from surgery to recovery and intensive care. RESULTS: Three themes emerged from the motor racing responses; (1) proactive learning with briefings and checklists to prevent errors; (2) active management using technology to transfer information, and (3) post hoc learning from the storage and analysis of electronic data records. The eight healthcare themes were: historical working practice; problems during transfer; poor awareness of handover protocols; poor team coordination; time pressure; lack of consistency in handover practice; poor communication of important information; and awareness that handover was a potential threat to patient safety. CONCLUSIONS: The lessons from motor racing can be applied to healthcare for proactive planning, active management and post hoc learning. Other high-risk industries see standardisation of working practices, interpersonal communication, consistency and continuous development as fundamental for success. The application of these concepts would result in improvements in the quality and safety of the patient handover process. DA - 2010/// PY - 2010 VL - 19 IS - 4 SP - 318 EP - 22 LA - en UR - https://dx.doi.org/10.1136/qshc.2009.026542 AN - rayyan-105241355 N1 -RAYYAN-INCLUSION: {"Anacaona"=>"Included"}
KW - Adulto KW - Entrevistas como Asunto KW - Humanos KW - Lista de Verificación KW - amp KW - control KW - Errores Médicos/prevención & KW - administración KW - Administración de la Seguridad KW - Aprendizaje Basado en Problemas/métodos KW - Continental Population Groups KW - Continuidad de la Atención al Paciente KW - Deportes KW - Desarrollo de Programa KW - Garantía de la Calidad de Atención de Salud/normas KW - Grupo de Atención al Paciente KW - Hospitales de Enseñanza/normas KW - Personal Administrativo KW - Reino Unido KW - Transferencia de Pacientes/organización & KW - Vías Clínicas ER - TY - JOUR TI - Improving care for the ventilated patient AU - Berenholtz, Sean M AU - Milanovich, Shelley AU - Faircloth, Amanda AU - Prow, Donna T AU - Earsing, Karen AU - Lipsett, Pamela AU - Dorman, Todd AU - Pronovost, Peter J T2 - The Joint Commission Journal on Quality and Safety DA - 2004/// PY - 2004 VL - 30 IS - 4 SP - 195 EP - 204 J2 - The Joint Commission Journal on Quality and Safety SN - 1549-3741 ER - TY - JOUR TI - Implementation of a mandatory checklist of protocols and objectives improves compliance with a wide range of evidence-based intensive care unit practices AU - Byrnes, Matthew C AU - Schuerer, Douglas JE AU - Schallom, Marilyn E AU - Sona, Carrie S AU - Mazuski, John E AU - Taylor, Beth E AU - McKenzie, Wendi AU - Thomas, James M AU - Emerson, Jeffrey S AU - Nemeth, Jennifer L T2 - Critical care medicine DA - 2009/// PY - 2009 VL - 37 IS - 10 SP - 2775 EP - 2781 J2 - Critical care medicine SN - 0090-3493 ER - TY - JOUR TI - Improving end-of-rotation transitions of care among ICU patients AU - Denson, Joshua Lee AU - Knoeckel, Julie AU - Kjerengtroen, Sara AU - Johnson, Rachel AU - McNair, Bryan AU - Thornton, Olivia AU - Douglas, Ivor S AU - Wechsler, Michael E AU - Burke, Robert E T2 - BMJ quality & safety DA - 2020/// PY - 2020 VL - 29 IS - 3 SP - 250 EP - 259 J2 - BMJ quality & safety SN - 2044-5415 ER - TY - JOUR TI - PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation AU - Tricco, Andrea C AU - Lillie, Erin AU - Zarin, Wasifa AU - O'Brien, Kelly K AU - Colquhoun, Heather AU - Levac, Danielle AU - Moher, David AU - Peters, Micah DJ AU - Horsley, Tanya AU - Weeks, Laura T2 - Annals of internal medicine DA - 2018/// PY - 2018 VL - 169 IS - 7 SP - 467 EP - 473 J2 - Annals of internal medicine SN - 0003-4819 ER - TY - JOUR TI - In: Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1. 0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www. cochrane‐handbook. org AU - Higgins, JPT AU - Altman, DG AU - Sterne, JAC DA - 2011/// PY - 2011 ER -