Publication: Checklist for Early Recognition and Treatment of Acute Illness and Injury: An Exploratory Multicenter International Quality-Improvement Study in the ICUs With Variable Resources
Issued Date
2021-06-01
Resource Type
ISSN
15300293
00903493
00903493
Other identifier(s)
2-s2.0-85106925965
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Mahidol University
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SCOPUS
Bibliographic Citation
Critical Care Medicine. Vol.49, No.6 (2021), E598-E612
Suggested Citation
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 Checklist for Early Recognition and Treatment of Acute Illness and Injury: An Exploratory Multicenter International Quality-Improvement Study in the ICUs With Variable Resources. Critical Care Medicine. Vol.49, No.6 (2021), E598-E612. doi:10.1097/CCM.0000000000004937 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/78161
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Title
Checklist for Early Recognition and Treatment of Acute Illness and Injury: An Exploratory Multicenter International Quality-Improvement Study in the ICUs With Variable Resources
Other Contributor(s)
CEDIMAT Centro Cardiovascular
Institute of Health Policy, Management and Evaluation
King Saud bin Abdulaziz University for Health Sciences
University of Novi Sad
Sunnybrook Health Sciences Centre
University of Toronto
Mahidol University
Nuffield Department of Medicine
Mayo Clinic
St James's Hospital
Universitat de Barcelona
Amsterdam UMC - University of Amsterdam
Institute for Pulmonary Diseases of Vojvodina
Institute of Health Policy, Management and Evaluation
King Saud bin Abdulaziz University for Health Sciences
University of Novi Sad
Sunnybrook Health Sciences Centre
University of Toronto
Mahidol University
Nuffield Department of Medicine
Mayo Clinic
St James's Hospital
Universitat de Barcelona
Amsterdam UMC - University of Amsterdam
Institute for Pulmonary Diseases of Vojvodina
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.