Language
English
Publication Date
12-1-2022
Journal
BMJ Open Quality
DOI
10.1136/bmjoq-2022-001824
PMID
36588320
PMCID
PMC9743379
PubMedCentral® Posted Date
12-8-2022
PubMedCentral® Full Text Version
Post-print
Abstract
Background and objectives: Structured and systematised checklists have been shown to prevent complications and improve patient care. We evaluated the implementation of systematic safety checklists in our neurocritical care unit (NCCU) and assessed its effect on patient outcomes.
Design/methods: This quality improvement project followed a Plan-Do-Study-Act (PDSA) methodology. A checklist for medication reconciliation, thromboembolic prophylaxis, glycaemic control, daily spontaneous awakening, breathing trial, diet, catheter/lines duration monitoring and antibiotics de-escalation was implemented during daily patient rounds. Main outcomes included the rate of new infections, mortality and NCCU-length of stay (LOS). Intervened patients were compared with historical controls after propensity score and Euclidean distance matching to balance baseline covariates.
Results: After several PDSA iterations, we applied checklists to 411 patients; the overall average age was 61.34 (17.39). The main reason for admission included tumour resection (31.39%), ischaemic stroke (26.76%) and intracerebral haemorrhage (10.95%); the mean Sequential Organ Failure Assessment (SOFA) score was 2.58 (2.68). At the end of the study, the checklist compliance rate throughout the full NCCU stays reached 97.11%. After controlling for SOFA score, age, sex and primary admitting diagnosis, the implementation of systematic checklists significantly correlated with a reduced LOS (ß=-0.15, 95% CI -0.24 to -0.06), reduced rate of any new infections (OR 0.59, 95% CI 0.40 to 0.87) and reduced urinary tract infections (UTIs) (OR 0.23, 95% CI 0.09 to 0.55). Propensity score and Euclidean distance matching yielded 382 and 338 pairs with excellent covariate balance. After matching, outcomes remained significant.
Discussion: The implementation of safety checklists in the NCCU proved feasible, easy to incorporate into the NCCU workflow, and a helpful tool to improve adherence to practice guidelines and quality of care measurements. Furthermore, our intervention resulted in a reduced NCCU-LOS, rate of new infections and rate of UTIs compared with propensity score and Euclidean distance matched historical controls.
Keywords
Humans, Middle Aged, Quality Improvement, Checklist, Brain Ischemia, Stroke, Hospitalization, quality improvement, health services research, checklists, critical care
Published Open-Access
yes
Recommended Citation
Escamilla-Ocañas, César E; Torrealba-Acosta, Gabriel; Mandava, Pitchaiah; et al., "Implementation of Systematic Safety Checklists in a Neurocritical Care Unit: A Quality Improvement Study" (2022). Faculty and Staff Publications. 5247.
https://digitalcommons.library.tmc.edu/baylor_docs/5247