Checklists Change Communication About Key Elements of Patient Care

Abstract

Background: Combat casualty care is distributed across professions and echelons of care. Communication within it is fragmented, inconsistent, and prone to failure. Daily checklists used during intensive care unit (ICU) rounds have been shown to improve compliance with evidence-based practices, enhance communication, promote consistency of care, and improve outcomes. Checklists are criticized because it is difficult to establish a causal link between them and their effect on outcomes. We investigated how checklists used during ICU rounds affect communication. METHODS: We conducted this project in two military ICUs (burn and surgical/trauma). Checklists contained up to 21 questions grouped according to patient population. We recorded which checklist items were discussed during rounds before and after implementation of a must address checklist and compared the frequency of discussing items before checklist prompting. RESULTS: Patient discussions addressed more checklist items before prompting at the end of the 2-week evaluation compared with the 2-week preimplementation period (surgical trauma ICU, 36% vs. 77%, p less than 0.0001; burn ICU, 47% vs. 72 %, p less than 0.001). Most items were addressed more frequently in both ICUs after implementation. Key items such as central line removal, reduction of laboratory testing, medication reconciliation, medication interactions, bowel movements, sedation holidays, breathing trials, and lung protective ventilation showed significant improvements. CONCLUSION: Checklists modify communication patterns. Improved communication facilitated by checklists may be one mechanism behind their effectiveness. Checklists are powerful tools that can rapidly alter patient care delivery.

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Document Details

Document Type
Technical Report
Publication Date
Jan 01, 2012
Accession Number
ADA616176

Entities

People

  • David A. Allen
  • Jeremy C. Pamplin
  • Kevin K Chung
  • Michelle Newkirk
  • Roderick Kuwamoto

Organizations

  • United States Army Institute of Surgical Research

Tags

DTIC Thesaurus Topics

  • Brain Injuries
  • Combat Casualty Care
  • Dermatologic Agents
  • Health Care
  • Health Services
  • Information Exchange
  • Medical Personnel
  • Military Medicine
  • Oxygenation
  • Patient Care
  • Personnel Management
  • Physicians
  • Therapy

Readers

  • Instructional Design and Training Evaluation.
  • Systems Analysis and Design
  • Trauma or Military Medicine