Checklist for Early Recognition and Treatment of Acute Illness and Injury: An Exploratory Multicenter International Quality-Improvement Study in the ICUs with Variable Resources

Marija Vukoja, Yue Dong, Neill K.J. Adhikari, Marcus J. Schultz, Yaseen M. Arabi, Ignacio Martin-Loeches, Manuel Hache, Srdjan Gavrilovic, Rahul Kashyap, Ognjen Gajic, Aida Mujakovic, Dragana Markotic, Zoran Karlovic, Min Shao, Zhigang Chang, Feihu Zhou, Hongjun Kang, Jianjun Gui, Yimin Li, Sibei ChenShouhong Wang, Xin Zhao, Haitao Lan, Lin Dou, Yan Kang, Xuelian Liao, Wei Liu, Alan Sustic, Danijel Knezevic, Jose Yunen, Rajyabardhan Pattnaik, Chandan Dey, Varma Muralidhar, Mradul Kumar Daga, Harpreet Singh, Emily Naylor, Juvelikian Georges, Jose Guillermo Dominguez Cherit, Su Jung Choi, Fatima Ajaz, Carolina L. Tapia, Erric Cinco, Anna Kluzik, Joanna Kaik, Maja Surbatovic, Mihailo Stojic, Uros Petrovic, Svetislava Milic, Sixtus Ruyumbu, Ozlem Cakin, Atilla Ramazanoglu, Vakil Abhay, Syed Anjum Khan, Joseph Poterucha, Rose M. Peterson, Parvez Mir, Hong I. Liao, Jovan Matijasevic, Pedja Kovacevic, Sasa Dragic, Milka Jandric, Danica Momcicevic, Hong Bo, Jun Guo, Bo Wang, Moldovan Sabov, Amelia Barwise, Reina Suzuki, Hongchuan Coville, Lisbeth Garcia Arguello, Lei Fan, Oguz Kilickaya

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish (US)
Pages (from-to)E598-E612
JournalCritical care medicine
DOIs
StateAccepted/In press - 2021

Keywords

  • checklist
  • global health
  • intensive care
  • quality improvement

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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