Checklist for Early Recognition and Treatment of Acute Illness and Injury: An Exploratory Multicenter International Quality-Improvement Study in the ICUs With Variable Resources. Issue 6 (23rd February 2021)

• Record Type: Journal Article
• Authors: Vukoja, Marija; Dong, Yue; Adhikari, Neill K. J.; Schultz, Marcus J.; Arabi, Yaseen M.; Martin-Loeches, Ignacio; Hache, Manuel; Gavrilovic, Srdjan; Kashyap, Rahul; Gajic, Ognjen
• Other Names: other.; contributor.; Mujakovic Aida author non-byline.; contributor.; Markotic Dragana author non-byline.; contributor.; Karlovic Zoran author non-byline.; contributor.; Shao Min author non-byline.; contributor.; Chang Zhigang author non-byline.; contributor.; Zhou Feihu author non-byline.; contributor.; Kang Hongjun author non-byline.; contributor.; Gui Jianjun author non-byline.; contributor.; Li Yimin author non-byline.; contributor.; Chen Sibei author non-byline.; contributor.; Wang Shouhong author non-byline.; contributor.; Zhao Xin author non-byline.; contributor.; Lan Haitao author non-byline.; contributor.; Dou Lin author non-byline.; contributor.; Kang Yan author non-byline.; contributor.; Liao Xuelian author non-byline.; contributor.; Liu Wei author non-byline.; contributor.; Sustic Alan author non-byline.; contributor.; Knezevic Danijel author non-byline.; contributor.; Yunen Jose author non-byline.; contributor.; Pattnaik Rajyabardhan author non-byline.; contributor.; Dey Chandan author non-byline.; contributor.; Muralidhar Varma author non-byline.; contributor.; Kumar Daga Mradul author non-byline.; contributor.; Singh Harpreet author non-byline.; contributor.; Naylor Emily author non-byline.; Georges Juvelikian author non-byline.; contributor.; Guillermo Dominguez Cherit Jose author non-byline.; contributor.; Jung Choi Su author non-byline.; contributor.; Ajaz Fatima author non-byline.; contributor.; Tapia Carolina L. author non-byline.; contributor.; Cinco Erric author non-byline.; contributor.; Kluzik Anna author non-byline.; contributor.; Kaik Joanna author non-byline.; contributor.; Surbatovic Maja author non-byline.; contributor.; Stojic Mihailo author non-byline.; contributor.; Petrovic Uros author non-byline.; contributor.; Milic Svetislava author non-byline.; contributor.; Ruyumbu Sixtus author non-byline.; contributor.; Cakin Ozlem author non-byline.; contributor.; Ramazanoglu Atilla author non-byline.; contributor.; Abhay Vakil author non-byline.; contributor.; Anjum Khan Syed author non-byline.; contributor.; Poterucha Joseph author non-byline.; contributor.; Peterson Rose M. author non-byline.; Mir Parvez author non-byline.; contributor.; Liao Hong-I author non-byline.; contributor.; Matijasevic Jovan author non-byline.; contributor.; Kovacevic Pedja author non-byline.; contributor.; Dragic Sasa author non-byline.; contributor.; Jandric Milka author non-byline.; contributor.; Momcicevic Danica author non-byline.; contributor.; Bo Hong author non-byline.; contributor.; Guo Jun author non-byline.; contributor.; Wang Bo author non-byline.; contributor.; Sabov Moldovan author non-byline.; contributor.; Barwise Amelia author non-byline.; contributor.; Suzuki Reina author non-byline.; contributor.; Coville Hongchuan author non-byline.; contributor.; Garcia Arguello Lisbeth author non-byline.; contributor.; Fan Lei author non-byline.; contributor.; Kilickaya Oguz author non-byline.; contributor.;
• Is Part Of: Critical care medicine. Volume 49:Issue 6(2021)
• Page Start: e598
• Page End: e612
• Publication Date: 2021-02-23
• Subjects: checklist -- global health -- intensive care -- quality improvement; Critical care medicine -- Periodicals; Soins intensifs -- Périodiques; 616.028
• DOI: 10.1097/CCM.0000000000004937
• Languages: English
• ISSNs: 0090-3493

Abstract

Abstract : Supplemental Digital Content is available in the text. Abstract : OBJECTIVES: To determine whether the "Checklist for Early Recognition and Treatment of Acute Illness and Injury" decision support tool during ICU admission and rounding is associated with improvements in nonadherence to evidence-based daily care processes and outcomes in variably resourced ICUs. DESIGN, SETTINGS, PATIENTS: This before-after study was performed in 34 ICUs (15 countries) from 2013 to 2017. Data were collected for 3 months before and 6 months after Checklist for Early Recognition and Treatment of Acute Illness and Injury implementation. INTERVENTIONS: Checklist for Early Recognition and Treatment of Acute Illness and Injury implementation using remote simulation training. MEASUREMENTS AND MAIN RESULTS: The coprimary outcomes, modified from the original protocol before data analysis, were nonadherence to 10 basic care processes and ICU and hospital length of stay. There were 1, 447 patients in the preimplementation phase and 2, 809 patients in the postimplementation phase. After adjusting for center effect, Checklist for Early Recognition and Treatment of Acute Illness and Injury implementation was associated with reduced nonadherence to care processes (adjusted incidence rate ratio [95% CI]): deep vein thrombosis prophylaxis (0.74 [0.68–0.81), peptic ulcer prophylaxis (0.46 [0.38–0.57]), spontaneous breathing trial (0.81 [0.76–0.86]), family conferences (0.86 [0.81–0.92]), and daily assessment for the need of central venous catheters (0.85 [0.81–0.90]), urinary catheters (0.84 [0.80–0.88]), antimicrobials (0.66 [0.62–0.71]), and sedation (0.62 [0.57–0.67]). Analyses adjusted for baseline characteristics showed associations of Checklist for Early Recognition and Treatment of Acute Illness and Injury implementation with decreased ICU length of stay (adjusted ratio of geometric means [95% CI]) 0.86 [0.80–0.92]), hospital length of stay (0.92 [0.85–0.97]), and hospital mortality (adjusted odds ratio [95% CI], 0.81 (0.69–0.95). CONCLUSIONS: A quality-improvement intervention with remote simulation training to implement a decision support tool was associated with decreased nonadherence to daily care processes, shorter length of stay, and decreased mortality.