BACKGROUND: Implementation of best practices for pediatric ICU (PICU) patients is challenging. The objective of this project was to improve process of care outcomes and clinical outcomes by having a dedicated person (quality champion [QC]) prompt PICU rounding teams to address a daily best practice rounding checklist.
METHODS: A prospective cohort study was performed in an academic tertiary referral PICU, which implemented a daily rounding checklist, including reminders to assess central line/urinary catheter need, sedation goals, sedative/paralytic need, enteral nutrition readiness, and extubation readiness. Data were collected on patient characteristics, process of care outcomes, and clinical outcomes over three periods: before and after the checklist was implemented and after the practice of prompting for checklist use was instituted.
RESULTS: Over nine months, 444 patients were included. The QC was present on rounds 94 of 139 (67.6%) days. Checklist adherence (all checklist items discussed daily) improved from 75.7% to 86.6% of patients. There was a reduction in urinary catheter days across all time periods (p = 0.001), and post hoc analysis showed fewer blood draws (p = 0.049) among patients for whom the QC was present consistently during rounds. There was also a decrease in PICU length of stay after the checklist was implemented (p = 0.008), although this may be due to less severity of illness in the prompted cohort.
CONCLUSION: Prompting PICU rounding teams to address a daily best practice rounding checklist may improve some process of care outcomes. Further study is needed to delineate long-term effects of this initiative.
}, year = {2019}, journal = {Jt Comm J Qual Patient Saf}, volume = {45}, pages = {543-551}, month = {08/2019}, issn = {1938-131X}, doi = {10.1016/j.jcjq.2019.05.012}, language = {eng}, }