Measurement Properties and Implementation of a Checklist to Assess Leadership Skills during Interdisciplinary Rounds in the Intensive Care Unit

Abstract

The implementation of interdisciplinary teams in the intensive care unit (ICU) has focused attention on leadership behavior. A daily recurrent situation in ICUs in which both leadership behavior and interdisciplinary teamwork are integrated concerns the interdisciplinary rounds (IDRs). Although IDRs are recommended to provide optimal interdisciplinary and patient-centered care, there are no checklists available for leading physicians. We tested the measurement properties and implementation of a checklist to assess the quality of leadership skills in interdisciplinary rounds. The measurement properties of the checklist, which included 10 essential quality indicators, were tested for interrater reliability and internal consistency and by factor analysis. The interrater reliability among 3 raters was good (κ, 0.85) and the internal consistency was acceptable (α, 0.74). Factor analysis showed all factor loadings on 1 domain (>0.65). The checklist was further implemented during videotaped IDRs which were led by senior physicians and in which 99 patients were discussed. Implementation of the checklist showed a wide range of “no” and “yes” scores among the senior physicians. These results may underline the need for such a checklist to ensure tasks are synchronized within the team.

Development and Implementation of a Coronary Care Unit Quality Improvement Checklist

“…The third quarter demonstrated marked improvement in correction rates for both the teaching and private services, as the checklist became more accepted by the team, aligned with the mission and better integrated into the workflow of the unit. Similar degrees in improvement in compliance with intensive care unit best practices were achieved with specialty aligned checklists applied in surgical, trauma and intensive care units [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37]. In addition, this study also validated that verbal review is an effective means to improve application of CCU best practices as has been shown in other ICU settings [23,36].…”

“…In response to the increased worldwide risk of complications and death associated with surgery, the World Health Organization (WHO) in 2008 developed and published practice guidelines to promote and ensure patient safety [39]. Based on the very favorable experience in the aviation industry with checklists [8], which ensure effective communication and teamwork and that all steps and procedures are followed reliably and consistently during all phases of flight, healthcare derived safety checklists evolved and have been incorporated to improve the quality of care and prevent ICU associated adverse events [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37]. Tarrago et al reported that by implementing a safety checklist in their pediatric intensive care unit, and supplementing with sending individual monthly reports to physicians about their compliance, they observed an improvement in the rate of adherence to safety measures, a reduction in the cost of care, and better compliance by physicians with standards of care [24].…”

“…Checklists are support tools to be used by healthcare providers, especially operating in challenging and complex environments such as intensive care units. They serve as cognitive and forcing function reminders to ensure safe practices, team communication and coordination and the application of evidence-based preventive strategies and guideline recommended therapies [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37].…”

“…Despite proven effectiveness in mostly observational studies, especially when the tool is embedded into care reliably, checklists are not uniformly or consistently used. Many challenges exist in their implementation and sustainable use and proving a direct relationship between the use of the tool and outcomes [27][28][29] has been evasive. Even though daily rounding checklists have been well described in medical, trauma, and pediatric and surgical intensive care units [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] with favorable results, there is no reported experience on the use and impact of a daily care checklist in the coronary care unit (CCU) setting, focusing on optimizing the management of complex and challenging critically ill cardiac patients and assuring the application of guideline recommended care.…”