Intensive care unit rounding checklist implementation. Effect of accountability measures on physician compliance.
RATIONALE/OBJECTIVES
Checklist utilization has been shown to improve multiple processes of care in the intensive care unit (ICU). The ICU setting makes checklist implementation challenging, particularly when prompters are unavailable to ensure checklist compliance. We performed a prospective analysis on physician compliance reporting as a means to improve attending physician compliance with checklist use during ICU rounds.


METHODS
We performed a prospective analysis of 14 attending physicians' compliance with checklist use before and after accountability measures employed at two urban academic hospitals in the United States. The accountability measures were bimonthly publication of physician checklist compliance via division e-mail and during a multidisciplinary division conference.


MEASUREMENTS AND MAIN RESULTS
A total of 5,812 patient days of ICU care were assessed from April 2013 through March 2014. Compliance with checklist use during ICU rounds improved at both academic hospitals during the intervention phase. Initial compliance rates were 67% at both institutions and subsequently improved to 90 and 81%, respectively, after accountability measures were employed. During a 3-month washout phase in which no public accountability measures were employed, compliance was maintained at 89 and 78% at the two hospitals. Foley catheter, central venous catheter, and ventilator utilization rates decreased after initiation of public accountability at both hospitals.


CONCLUSIONS
Physician compliance reporting can be used to improve ICU physician compliance with rounding checklists when prompters are unavailable. Improved physician compliance translated into decreased rates of Foley catheter, central venous catheter, and ventilator use. These results highlight the impact physician accountability can have on patient care in the ICU.
['Carlos|William G|WG|', 'Patel|Damien G|DG|', 'Vannostrand|Keriann M|KM|', 'Gupta|Shikha|S|', 'Cucci|Anthony R|AR|', 'Bosslet|Gabriel T|GT|']
D000046:Academic Medical Centers D062905:Central Venous Catheters D057189:Checklist D003422:Critical Care D030881:Disclosure D006801:Humans D007362:Intensive Care Units D008505:Medical Staff, Hospital D011446:Prospective Studies D058996:Quality Improvement D011787:Quality of Health Care D012121:Respiration, Artificial D012941:Social Responsibility D056164:Teaching Rounds D062885:Urinary Catheters
intensive care unit critical care patient safety quality improvement