Cookies on this website
We use cookies to ensure that we give you the best experience on our website. If you click 'Continue' we'll assume that you are happy to receive all cookies and you won't see this message again. Click 'Find out more' for information on how to change your cookie settings.

ObjectivesTo determine whether the "Checklist for Early Recognition and Treatment of Acute Illness and Injury" decision support tool during ICU admission and rounding is associated with improvements in nonadherence to evidence-based daily care processes and outcomes in variably resourced ICUs.Design, settings, patientsThis before-after study was performed in 34 ICUs (15 countries) from 2013 to 2017. Data were collected for 3 months before and 6 months after Checklist for Early Recognition and Treatment of Acute Illness and Injury implementation.InterventionsChecklist for Early Recognition and Treatment of Acute Illness and Injury implementation using remote simulation training.Measurements and main resultsThe coprimary outcomes, modified from the original protocol before data analysis, were nonadherence to 10 basic care processes and ICU and hospital length of stay. There were 1,447 patients in the preimplementation phase and 2,809 patients in the postimplementation phase. After adjusting for center effect, Checklist for Early Recognition and Treatment of Acute Illness and Injury implementation was associated with reduced nonadherence to care processes (adjusted incidence rate ratio [95% CI]): deep vein thrombosis prophylaxis (0.74 [0.68-0.81), peptic ulcer prophylaxis (0.46 [0.38-0.57]), spontaneous breathing trial (0.81 [0.76-0.86]), family conferences (0.86 [0.81-0.92]), and daily assessment for the need of central venous catheters (0.85 [0.81-0.90]), urinary catheters (0.84 [0.80-0.88]), antimicrobials (0.66 [0.62-0.71]), and sedation (0.62 [0.57-0.67]). Analyses adjusted for baseline characteristics showed associations of Checklist for Early Recognition and Treatment of Acute Illness and Injury implementation with decreased ICU length of stay (adjusted ratio of geometric means [95% CI]) 0.86 [0.80-0.92]), hospital length of stay (0.92 [0.85-0.97]), and hospital mortality (adjusted odds ratio [95% CI], 0.81 (0.69-0.95).ConclusionsA quality-improvement intervention with remote simulation training to implement a decision support tool was associated with decreased nonadherence to daily care processes, shorter length of stay, and decreased mortality.

Original publication

DOI

10.1097/ccm.0000000000004937

Type

Journal

Critical care medicine

Publication Date

23/02/2021

Addresses

1 The Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia. 2 Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia. 3 Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN. 4 Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada. 5 Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada. 6 Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada. 7 Department of Intensive Care, Amsterdam University Medical Centers, Amsterdam, The Netherlands. 8 Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A), Amsterdam University Medical Centers, Amsterdam, The Netherlands. 9 Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand. 10Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom. 11 Department of Intensive Care, King Abdullah International Medical Research Center (KAIMRC), College of Medicine, King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Kingdom of Saudi Arabia. 12 Multidisciplinary Intensive Care Research Organization, St James's Hospital, Dublin, Ireland. 13 Department of Pulmonology, Hospital Clínic de Barcelona, Universitat de Barcelona and IDIBAPS, Barcelona, Spain. 14 Centro de Investigación Biomédica en Red (CIBER), University of Barcelona, Barcelona, Spain. 15 Centro De Diagnostica Imagenes Medicina Avanzaday, Telemedicina CEDIMAT, Santo Domingo, Dominican Republic. 16 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN.

Keywords

Checklist for Early Recognition and Treatment of Acute Illness and Injury (CERTAIN) Investigators of the SCCM Discovery Network