The impact of the CERTAIN clinical decision support tool for structured intensive care unit admission and rounding is patient sex-independent: a secondary analysis of CERTAIN

Abstract

Objective: Implementing the Checklist for Early Recognition and Treatment of Acute Illness and Injury (CERTAIN) decision support tool for structured intensive care unit admission and rounding was associated with an increased adherence to best care practices. We determined whether this association was patient sex-dependent. Design: Post hoc analysis of CERTAIN. Setting: A prospective multinational quality improvement study. Patients: Adult patients admitted to one of the participating intensive care units. Interventions: Implementation of the CERTAIN decision support tool. Measurements: We compared incidence rates of omission of delivery of ten best care practices, including deep vein thrombosis and peptic ulcer prophylaxis, head of bed elevation, daily oral care, spontaneous breathing trials, family conferences, assessment of need for central lines and urinary catheters, and prescription of antimicrobials and sedation, between sexes, before and after implementation of the decision support tool. In addition, we determined whether sex differences existed amongst high-and middle-income countries. Main results: CERTAIN comprised a total of 4,256 patients, with 588 females and 859 males before the implementation of the decision support tool and 1,169 females and 1,640 males after its implementation. Overall, there was no notable difference in care between sexes, neither before nor after implementation, and both sexes in high-income and middle-income countries experienced equal benefits from checklist implementation. Conclusion: The impact of a clinical decision support tool for structured intensive care unit admission and rounding on adherence to best care practices showed minimal variation between sexes.