1. Intelligent checklists improve checklist compliance in the intensive care unit
- Author
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Xudong Lu, Wilma Compagner, Erik Korsten, Alexander J. G. H. Bindels, Ashley J.R. De Bie, Lenneke van Genugten, Harald van de Pol, Jacco Eerden, Eveline Mestrom, Steffen van Leeuwen, Kiran Dellimore, Arthur Bouwman, Franklin Harold Schuling, Shan Nan, Eindhoven MedTech Innovation Center, Signal Processing Systems, Center for Care & Cure Technology Eindhoven, Biomedical Diagnostics Lab, and EAISI Health
- Subjects
Health Status ,Decision Support Systems ,Practice Patterns ,intensive care unit ,law.invention ,0302 clinical medicine ,030202 anesthesiology ,Interquartile range ,law ,patient safety ,Medicine ,Prospective Studies ,Teaching Rounds/standards ,Practice Patterns, Physicians' ,Prospective cohort study ,Attitude to Computers ,Quality Indicators, Health Care/standards ,Intensive care unit ,Quality Improvement ,Checklist ,Benchmarking ,Intensive Care Units ,clinical decision support system ,Practice Guidelines as Topic ,medical errors ,Guideline Adherence/standards ,Guideline Adherence ,Practice Guidelines as Topic/standards ,Paper ,medicine.medical_specialty ,Critical Care ,Health Care/standards ,Context (language use) ,Physicians'/standards ,03 medical and health sciences ,Patient safety ,Clinical ,Artificial Intelligence ,Intensive care ,technology acceptance ,Humans ,Practice Patterns, Physicians'/standards ,Critical Care/standards ,Quality Indicators, Health Care ,Benchmarking/standards ,business.industry ,Length of Stay ,Decision Support Systems, Clinical ,Quality Improvement/standards ,Clinical trial ,Anesthesiology and Pain Medicine ,Intensive Care Units/standards ,Emergency medicine ,Teaching Rounds ,Quality Indicators ,business - Abstract
Background We examined whether a context and process-sensitive ‘intelligent' checklist increases compliance with best practice compared with a paper checklist during intensive care ward rounds. Methods We conducted a single-centre prospective before-and-after mixed-method trial in a 35 bed medical and surgical ICU. Daily ICU ward rounds were observed during two periods of 8 weeks. We compared paper checklists (control) with a dynamic (digital) clinical checklist (DCC, intervention). The primary outcome was compliance with best clinical practice, measured as the percentages of checked items and unchecked critical items. Secondary outcomes included ICU stay and the usability of digital checklists. Data are presented as median (interquartile range). Results Clinical characteristics and severity of critical illness were similar during both control and intervention periods of study. A total of 36 clinicians visited 197 patients during 352 ward rounds using the paper checklist, compared with 211 patients during 366 ward rounds using the DCC. Per ICU round, a median of 100% of items (94.4–100.0) were completed by DCC, compared with 75.1% (66.7–86.4) by paper checklist (P=0.03). No critical items remained unchecked by the DCC, compared with 15.4% (8.3–27.3) by the paper checklist (P=0.01). The DCC was associated with reduced ICU stay (1 day [1–3]), compared with the paper checklist (2 days [1–4]; P=0.05). Usability of the DCC was judged by clinicians to require further improvement. Conclusions A digital checklist improved compliance with best clinical practice, compared with a paper checklist, during ward rounds on a mixed ICU. Clinical trial registration NCT 03599856.
- Published
- 2021
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