by Vukoja, Marija MD, PhD1,2; Dong, Yue MD3; Adhikari, Neill
K. J. MDCM, MSc4–6; Schultz, Marcus J. MD, PhD7–10; Arabi, Yaseen M. MD11;
Martin-Loeches, Ignacio MD, PhD12–14; Hache, Manuel MD15; Gavrilovic, Srdjan MD1,2;
Kashyap, Rahul MB BS, MBA3; Gajic, Ognjen MD, MSc16; for the Checklist for
Early Recognition and Treatment of Acute Illness and Injury (CERTAIN)
Investigators of the SCCM Discovery Network Checklist for Early
Recognition and Treatment of Acute Illness and Injury (CERTAIN)
Critical Care
Medicine: June 2021 -
Volume 49 - Issue 6 - p e598-e612
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.
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