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Abstract

Introduction: The pediatric critical care unit (PICU) is an environment in which complexity of care can contribute to both medical errors and increased costs. Novel methods are needed to combat these issues. Hypothesis: The goal of this study was to determine if a) the use of a daily safety checklist reduces device use and costs, and improves adherence to standard therapies and b) conversion from a paper to an electronic checklist enhances those improvements. Methods: This was a retrospective case control series over 21-months totaling 4001 patient days in a thirteen bed PICU. A daily safety checklist was used to prompt the care team to address multiple quality and safety items. The initial checklist was paper, with two subsequent versions being incorporated into the electronic medical record. Eight measures were analyzed for three intervention periods and compared to baseline. Measures included central venous, arterial and urinary catheter days, percent intravenous (IV) doses of furosemide and ranitidine, number of antibiotic doses and laboratory studies, and use of gastric ulcer prophylaxis and continuous end-tidal CO2 monitoring in ventilated patients. Results: Catheter days per patient day decreased for central venous (0.75 vs. 0.41), arterial (0.18 vs. 0.12) and urinary catheters (0.43 vs. 0.32) (p < 0.001). The percent of IV doses for furosemide decreased from 77% to 46%, resulting in 847 fewer IV line entries. Antibiotic exposure decreased from 3.7 to 2.4 doses per patient per day, a reduction of 33% (p < 0.001). Laboratory test use decreased from 11.7 tests per patient per day to 5.8 in the final period (p<0.001), and resulted in charge savings of over $500 per patient per day. Use of gastric ulcer prophylaxis and continuous end-tidal CO2 monitoring increased by 15% and 117%, respectively. Conclusions: Use of a daily safety checklist in the pediatric critical care unit reduces the use of invasive devices, decreases health care costs, and improves compliance with standards of care. Incorporating the checklist into the electronic medical record improves compliance and accountability, ensuring its application to all patients.