1
|
De Bie AJR, Mestrom E, Compagner W, Nan S, van Genugten L, Dellimore K, Eerden J, van Leeuwen S, van de Pol H, Schuling F, Lu X, Bindels AJGH, Bouwman ARA, Korsten EHHM. Intelligent checklists improve checklist compliance in the intensive care unit: a prospective before-and-after mixed-method study. Br J Anaesth 2020; 126:404-414. [PMID: 33213832 DOI: 10.1016/j.bja.2020.09.044] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 09/21/2020] [Accepted: 09/21/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND We examined whether a context and process-sensitive 'intelligent' checklist increases compliance with best practice compared with a paper checklist during intensive care ward rounds. METHODS We conducted a single-centre prospective before-and-after mixed-method trial in a 35 bed medical and surgical ICU. Daily ICU ward rounds were observed during two periods of 8 weeks. We compared paper checklists (control) with a dynamic (digital) clinical checklist (DCC, intervention). The primary outcome was compliance with best clinical practice, measured as the percentages of checked items and unchecked critical items. Secondary outcomes included ICU stay and the usability of digital checklists. Data are presented as median (interquartile range). RESULTS Clinical characteristics and severity of critical illness were similar during both control and intervention periods of study. A total of 36 clinicians visited 197 patients during 352 ward rounds using the paper checklist, compared with 211 patients during 366 ward rounds using the DCC. Per ICU round, a median of 100% of items (94.4-100.0) were completed by DCC, compared with 75.1% (66.7-86.4) by paper checklist (P=0.03). No critical items remained unchecked by the DCC, compared with 15.4% (8.3-27.3) by the paper checklist (P=0.01). The DCC was associated with reduced ICU stay (1 day [1-3]), compared with the paper checklist (2 days [1-4]; P=0.05). Usability of the DCC was judged by clinicians to require further improvement. CONCLUSIONS A digital checklist improved compliance with best clinical practice, compared with a paper checklist, during ward rounds on a mixed ICU. CLINICAL TRIAL REGISTRATION NCT03599856.
Collapse
Affiliation(s)
- Ashley J R De Bie
- Department of Internal Medicine, Catharina Hospital Eindhoven, Eindhoven, The Netherlands; Industrial Engineering and Innovation Sciences, Eindhoven University of Technology, Eindhoven, The Netherlands; Department of Intensive Care Unit, Catharina Hospital Eindhoven, Eindhoven, The Netherlands.
| | - Eveline Mestrom
- Department of Internal Medicine, Catharina Hospital Eindhoven, Eindhoven, The Netherlands; Industrial Engineering and Innovation Sciences, Eindhoven University of Technology, Eindhoven, The Netherlands; Department of Intensive Care Unit, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Wilma Compagner
- Healthcare Intelligence, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Shan Nan
- Industrial Engineering and Innovation Sciences, Eindhoven University of Technology, Eindhoven, The Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands; College of Biomedical Engineering and Instrumental Science, Zhejiang University, Hangzhou, China
| | - Lenneke van Genugten
- Department of Brain, Behaviour and Cognition, Philips Research, Eindhoven, The Netherlands
| | - Kiran Dellimore
- Department of Patient Care and Measurements, Philips Research, Eindhoven, The Netherlands
| | - Jacco Eerden
- Department of Philips Design, Eindhoven, The Netherlands
| | | | - Harald van de Pol
- Healthcare Intelligence, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | | | - Xudong Lu
- College of Biomedical Engineering and Instrumental Science, Zhejiang University, Hangzhou, China
| | | | - Arthur R A Bouwman
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands; Department of Anaesthesiology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Erik H H M Korsten
- Department of Intensive Care Unit, Catharina Hospital Eindhoven, Eindhoven, The Netherlands; Healthcare Intelligence, Catharina Hospital Eindhoven, Eindhoven, The Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| |
Collapse
|