Effect of a Quality Improvement Intervention With Daily Round Checklists, Goal Setting, and Clinician Prompting on Mortality of Critically Ill Patients

Cavalcanti, Alexandre Biasi; Bozza, Fernando A.; Machado, Flávia Ribeiro; Salluh, Jorge I.; Campagnucci, Valquíria Pelisser; Vendramim, Patrícia; Guimarães, Hélio Penna; Normílio-Silva, Karina; Damiani, Lucas Petri; Romano, Edson; Carrara, F; Souza, Juliana Lubarino Diniz De; Silva, Aline Reis; Ramos, Grazielle Viana; Teixeira, Cassiano; Silva, Nilton Brandão da; Chang, Chung Chou H.; Angus, Derek C.; Berwanger, Otávio

doi:10.1001/jama.2016.3463

Cited by 145 publications

(83 citation statements)

References 35 publications

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“…Hospital acquired infections in the Intensive Care Unit (ICU) result in patient morbidity and mortality [1]. Environmental contamination in hospitals wards and ICUs is a recognized problem for infection prevention and control [2–7], as the environment may facilitate transmission of several important health care-associated pathogens, including gram-negative bacilli (GNB) [8].…”

Section: Introductionmentioning

confidence: 99%

Reduced rate of intensive care unit acquired gram-negative bacilli after removal of sinks and introduction of ‘water-free’ patient care

Hopman

Tostmann

Wertheim

et al. 2017

Antimicrob Resist Infect Control

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BackgroundSinks in patient rooms are associated with hospital-acquired infections. The aim of this study was to evaluate the effect of removal of sinks from the Intensive Care Unit (ICU) patient rooms and the introduction of ‘water-free’ patient care on gram-negative bacilli colonization rates.MethodsWe conducted a 2-year pre/post quasi-experimental study that compared monthly gram-negative bacilli colonization rates pre- and post-intervention using segmented regression analysis of interrupted time series data. Five ICUs of a tertiary care medical center were included. Participants were all patients of 18 years and older admitted to our ICUs for at least 48 h who also received selective digestive tract decontamination during the twelve month pre-intervention or the twelve month post-intervention period. The effect of sink removal and the introduction of ‘water-free’ patient care on colonization rates with gram-negative bacilli was evaluated. The main outcome of this study was the monthly colonization rate with gram-negative bacilli (GNB). Yeast colonization rates were used as a ‘negative control’. In addition, colonization rates were calculated for first positive culture results from cultures taken ≥3, ≥5, ≥7, ≥10 and ≥14 days after ICU-admission, rate ratios (RR) were calculated and differences tested with chi-squared tests.ResultsIn the pre-intervention period, 1496 patients (9153 admission days) and in the post-intervention period 1444 patients (9044 admission days) were included. Segmented regression analysis showed that the intervention was followed by a statistically significant immediate reduction in GNB colonization in absence of a pre or post intervention trend in GNB colonization. The overall GNB colonization rate dropped from 26.3 to 21.6 GNB/1000 ICU admission days (colonization rate ratio 0.82; 95%CI 0.67–0.99; P = 0.02). The reduction in GNB colonization rate became more pronounced in patients with a longer ICU-Length of Stay (LOS): from a 1.22-fold reduction (≥2 days), to a 1.6-fold (≥5 days; P = 0.002), 2.5-fold (for ≥10 days; P < 0.001) to a 3.6-fold (≥14 days; P < 0.001) reduction.ConclusionsRemoval of sinks from patient rooms and introduction of a method of ‘water-free’ patient care is associated with a significant reduction of patient colonization with GNB, especially in patients with a longer ICU length of stay.Electronic supplementary materialThe online version of this article (doi:10.1186/s13756-017-0213-0) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Reduced rate of intensive care unit acquired gram-negative bacilli after removal of sinks and introduction of ‘water-free’ patient care

Hopman

Tostmann

Wertheim

et al. 2017

Antimicrob Resist Infect Control

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“…A large cluster randomized trial of Brazilian ICUs published in 2016 demonstrated the effectiveness of team-based interventions for multiple ICU processes of care (20). This intervention was performed in ICUs that had not previously performed multi-disciplinary rounding, and included the institution of daily multi-disciplinary rounds that included the use of checklists to evaluate adherence to ICU processes of care, and daily goal setting among team members.…”

Section: What Are Effective Strategies To Improve Low Tidal Volume Vementioning

confidence: 99%

Translating evidence into practice in acute respiratory distress syndrome: teamwork, clinical decision support, and behavioral economic interventions

Sjoding

2017

Current Opinion in Critical Care

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Purpose of the review While the treatment of the Acute Respiratory Distress Syndrome (ARDS) with low tidal volume (LTV) mechanical ventilation improves mortality, it is not consistently administered in clinical practice. This review examines strategies to improve LTV and other evidence-based therapies for patients with ARDS. Recent findings Despite the well-established role of LTV in the treatment of ARDS, a recent multi-national study suggests it is under-utilized in clinical practice. Strategies to improve LTV include audit and feedback, provider education, protocol development, interventions to improve ICU teamwork, computer decision support, and behavioral economic interventions such as making LTV the default ventilator setting. These strategies typically target all patients receiving invasive mechanical ventilation, effectively avoiding the problem of poor ARDS recognition in clinical practice. To more effectively administer advanced ARDS therapies, such as prone positioning, better approaches for ARDS recognition will also be required. Summary Multiple strategies can be utilized to improve adherence to low tidal volume ventilation in ARDS patients.

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“…Recently, a large randomized controlled trial from Brazil reported that implementation of a multifaceted quality improvement intervention with daily checklists, goal setting, and clinician prompting did not reduce in-hospital mortality (11). The study is uniquely designed as in the initial observational phase of the trial, the authors have assessed baseline data on work climate, care processes, and clinical outcomes in the participating ICU and in the later phase, the same ICUs were randomized to a quality improvement intervention, including a daily checklist and goal setting during multidisciplinary rounds with follow-up clinician prompting for 11 care processes, or to routine care.…”

mentioning

confidence: 99%

Checklist & prompting in intensive care unit: quality of care is improved but long way to go for better outcome

Maitra

2017

J. Thorac. Dis.

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Effect of a Quality Improvement Intervention With Daily Round Checklists, Goal Setting, and Clinician Prompting on Mortality of Critically Ill Patients

Cited by 145 publications

References 35 publications

Reduced rate of intensive care unit acquired gram-negative bacilli after removal of sinks and introduction of ‘water-free’ patient care

Reduced rate of intensive care unit acquired gram-negative bacilli after removal of sinks and introduction of ‘water-free’ patient care

Translating evidence into practice in acute respiratory distress syndrome: teamwork, clinical decision support, and behavioral economic interventions

Checklist & prompting in intensive care unit: quality of care is improved but long way to go for better outcome

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