Daily Checklists and Outcome in the Intensive Care Unit

Not Applicable

Completed

Brief Summary: Medical errors account for tens of thousands of deaths and tens of billions of dollars in healthcare costs in the United States every year. One field that has seen the strongest push toward quality improvement has been critical care medicine, likely because its particularly high degree of medical complexity makes it a practice area prone to high error rates with serious consequences. One of the most commonly used interventions used to help reduce errors in the intensive care unit (ICU) has been the implementation of checklists.

The investigators propose a clinical trial in a University critical care setting to determine whether an electronic checklist versus verbal prompting to use a written checklist improves clinical practice and patient outcomes. The investigators also plan to compare these data with a time period prior to the study to determine if the electronic checklist or verbal prompting are better than usual care. The investigators hypothesize that both the electronic checklist and verbal prompting to use a written checklist will be better for clinical practice and patient outcomes than usual care, and that verbal prompting will lead to better outcomes compared to the electronic checklist.

Recruitment & Eligibility

Inclusion Criteria

Admission to a medical intensive care unit (MICU) team during the study timeframe

Exclusion Criteria

Transfer from MICU team to a separate ICU team within 12 hours of admission
Transfer to MICU team from a separate ICU team after more than 72 hours on the separate ICU team

Arm && Interventions

Group	Intervention	Description
Electronic checklist	Electronic checklist	Electronic checklist
Verbal prompting	Verbal prompting	Verbal prompting with written checklist

Primary Outcome Measures

Name	Time	Method
Empiric Antibiotic Duration	During intensive care unit admission, an average of 5 days per patient (although individual patients may vary)
Proportion of Empiric Antibiotics	ICU admission	The difference between the electronic checklist and prompted groups' proportion of all antibiotics that were administered empirically (empiric/total antibiotics).

Secondary Outcome Measures

Name	Time	Method
Hospital Mortality	During hospitalization, an average of 2 weeks per patient (although individual patients may vary)
Length of Stay	During hospitalization, an average of 2 weeks per patient (although individual patients may vary)
Ventilator-free Days	During hospitalization, an average of 2 weeks per patient (although individual patients may vary)	Number of days within the first 28 days after ICU admission that a patient does not require mechanical ventilation.
Proportion of Successful Prompts	During ICU admission, an average of 5 days (although individual patients may vary)	Prompting group: number of patient-days that prompting led to empirical antibiotics being discontinued or narrowed/number of patient-days prompting occurred Electronic checklist group: number of patient-days that electronic checklist led to empirical antibiotics being discontinued or narrowed/number of patient-days electronic checklist was completed
Proportion of Patients-days on Which Empirical Antibiotics Were Used	ICU admission	Proportion of patients-days on which empirical antibiotics were used
Standardized Mortality Ratio	Hospital admission

Locations (2): Northwestern Memorial Hospital
🇺🇸
Chicago, Illinois, United States
Northwestern University
🇺🇸
Chicago, Illinois, United States

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