Prompting Rounding Teams to Address a Daily Best Practice Checklist in a Pediatric Intensive Care Unit

Abstract

Implementation of best practices for pediatric ICU (PICU) patients is challenging. The objective of this project was to improve process of care outcomes and clinical outcomes by having a dedicated person (quality champion [QC]) prompt PICU rounding teams to address a daily best practice rounding checklist. A prospective cohort study was performed in an academic tertiary referral PICU, which implemented a daily rounding checklist, including reminders to assess central line/urinary catheter need, sedation goals, sedative/paralytic need, enteral nutrition readiness, and extubation readiness. Data were collected on patient characteristics, process of care outcomes, and clinical outcomes over three periods: before and after the checklist was implemented and after the practice of prompting for checklist use was instituted. Over nine months, 444 patients were included. The QC was present on rounds 94 of 139 (67.6%) days. Checklist adherence (all checklist items discussed daily) improved from 75.7% to 86.6% of patients. There was a reduction in urinary catheter days across all time periods (p = 0.001), and post hoc analysis showed fewer blood draws (p = 0.049) among patients for whom the QC was present consistently during rounds. There was also a decrease in PICU length of stay after the checklist was implemented (p = 0.008), although this may be due to less severity of illness in the prompted cohort. Prompting PICU rounding teams to address a daily best practice rounding checklist may improve some process of care outcomes. Further study is needed to delineate long-term effects of this initiative.