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Abstract

Introduction: There are some studies done in adults that demonstrate implementation of best practices with bedside checklists. We wanted to determine the effect of bedside checklists in the pediatric ICU. Methods: This prospective observational study included a checklist with 9 domains that was used daily during morning bedside rounds for patients under the age of 18 years admitted to the pediatric ICU in May 2013. Data was collected on daily patient encounters. Patients admitted over 15 days were excluded from the study. The 9 domains were decided upon after careful consideration of important interventions that are, in most circumstances, inadvertently overlooked; but when implemented optimize cost, patient comfort and safety, and resource utilization. Simple descriptive statistics was used to analyze baseline data, and percentages were used to determine consideration of the domains in the checklist and implementation of practice changes. Results: There were 34 patients and 94 encounters. Mean age was 77 ± 63.5 months, mean weight 27.2 ± 23.3 kg. There was 100% compliance (all 94 encounters) on consideration and discussion about all 9 domains after checklist use was started. 1) PICU status change: 72 encounters were PICU status, changed to intermediate 38% of time after discussion; 2) change of vital sign check from every 1 hour: 45 encounters vitals check every 1 hour, 31% changed after discussion; 3) intravenous (IV) steroid change to oral (PO): 16 encounters getting IV -50% changed after discussion; 4) IV ranitidine change to PO: 32 encounters getting IV -32% changed after discussion; 5) scheduled CBC: 17% of encounters- 25% changed after discussion; 6) scheduled basic metabolic panel: 15% of encounters -57% changed after discussion; 7) scheduled blood gas: 19% of encounters - 62% changed after duscussion; 8) scheduled chest X-ray: 6% of encounters - 17% changed after discussion; 9) discharge to home time: discussion about discharge was done 100% of time, 59% of the 34 patients were discharged during the study period, expected time to discharge was written on 65% of discharges and 85% of discharges was done within 4 hours of that time. Conclusions: Mandatory bedside checklist consisting of important management goals in the pediatric ICU is a simple, effective tool to prompt simple decision making that are important aspects of overall quality health care delivery, but may otherwise be overlooked in the setting of more urgent matters.