Department of Internal Medicine.
Intensive Care Unit, Catharina Hospital Eindhoven, Eindhoven, The Netherlands.
Br J Anaesth. 2017 Aug 1;119(2):231-238. doi: 10.1093/bja/aex129.
Checklists can reduce medical errors. However, the effectiveness of checklists is hampered by lack of acceptance and compliance. Recently, a new type of checklist with dynamic properties has been created to provide more specific checklist items for each individual patient. Our purpose in this simulation-based study was to investigate a newly developed intelligent dynamic clinical checklist (DCC) for the intensive care unit (ICU) ward round.
Eligible clinicians were invited to participate as volunteers. Highest achievable scores were established for six typical ICU scenarios to determine which items must be checked. The participants compared the DCC with the local standard of care. The primary outcomes were the caregiver satisfaction score and the percentages of checked items overall and of critical items requiring a direct intervention.
In total, 20 participants were included, who performed 116 scenarios. The median percentage of checked items was 100.0% with the DCC and 73.6% for the scenarios completed with local standard of care ( P <0.001). Critical items remained unchecked in 23.1% of the scenarios performed with local standard of care and 0.0% of the scenarios where the DCC was available ( P <0.001). The mean satisfaction score of the DCC was 4.13 out of 5.
This simulation study indicates that an intelligent DCC significantly increases compliance with best practice by reducing the percentage of unchecked items during ICU ward rounds, while the user satisfaction rate remains high. Real-life clinical research is required to evaluate this new type of checklist further.
清单可以减少医疗错误。然而，由于缺乏接受度和依从性，清单的有效性受到了阻碍。最近，一种具有动态特性的新型清单被创建出来，以便为每个个体患者提供更具体的清单项目。我们在这项基于模拟的研究中的目的是调查一种新开发的智能动态临床清单（DCC）在重症监护病房（ICU）查房中的应用。
邀请合格的临床医生作为志愿者参与。为六个典型的 ICU 场景确定了最高可达分数，以确定必须检查哪些项目。参与者将 DCC 与当地的护理标准进行了比较。主要结果是护理人员满意度评分以及总体检查项目的百分比和需要直接干预的关键项目的百分比。
共有 20 名参与者参与，共进行了 116 个场景。使用 DCC 检查的项目百分比中位数为 100.0%，而使用当地标准护理完成的场景中为 73.6%（P<0.001）。在使用当地标准护理完成的场景中，23.1%的关键项目未被检查，而在有 DCC 可用的场景中则为 0.0%（P<0.001）。DCC 的平均满意度评分为 5 分制的 4.13 分。
这项模拟研究表明，智能 DCC 通过减少 ICU 查房期间未检查项目的百分比，显著提高了最佳实践的依从性，而用户满意度仍然很高。需要进行真实的临床研究来进一步评估这种新型清单。
