Prompting Rounding Teams to Address a Daily Best Practice Checklist in a Pediatric Intensive Care Unit

摘要

Background: Implementation of best practices for pediatric ICU (PICU) patients is challenging. The objective of this projectwas to improve process of care outcomes and clinical outcomes by having a dedicated person (quality champion [QC]) promptPICU 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 roundingchecklist, including reminders to assess central line/urinary catheter need, sedation goals, sedative/paralytic need, enteral nutritionreadiness, and extubation readiness. Data were collected on patient characteristics, process of care outcomes, and clinical outcomesover 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. Checklistadherence (all checklist items discussed daily) improved from 75.7% to 86.6% of patients. There was a reduction in urinarycatheter days across all time periods (p = 0.001), and post hoc analysis showed fewer blood draws (p = 0.049) among patientsfor whom the QC was present consistently during rounds. There was also a decrease in PICU length of stay after the checklistwas 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 processof care outcomes. Further study is needed to delineate long-term effects of this initiative