Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, USA.
Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
BMJ Qual Saf. 2018 Oct;27(10):836-843. doi: 10.1136/bmjqs-2017-007218. Epub 2018 Mar 23.
Rounding checklists are an increasingly common quality improvement tool in the intensive care unit (ICU). However, effectiveness studies have shown conflicting results. We sought to understand ICU providers' perceptions of checklists, as well as barriers and facilitators to effective utilisation of checklists during daily rounds.
To understand how ICU providers perceive rounding checklists and develop a framework for more effective rounding checklist implementation.
We performed a qualitative study in 32 ICUs within 14 hospitals in a large integrated health system in the USA. We used two complementary data collection methods: direct observation of daily rounds and semistructured interviews with ICU clinicians. Observations and interviews were thematically coded and primary themes were identified using a combined inductive and deductive approach.
We conducted 89 interviews and performed 114 hours of observation. Among study ICUs, 12 used checklists and 20 did not. Participants described the purpose of rounding checklists as a daily reminder for evidence-based practices, a tool for increasing shared understanding of patient care across care providers and a way to increase the efficiency of rounds. Checklists were perceived as not helpful when viewed as overstandardising care and when they are not relevant to a particular ICU's needs. Strategies to improve checklist implementation include attention to the brevity and relevance of the checklist to the particular ICU, consistent use over time, and integration with daily work flow.
Our results provide potential insights about why ICU rounding checklists frequently fail to improve outcomes and offer a framework for effective checklist implementation through greater feedback and accountability.
在重症监护病房（ICU）中，查房核对表是一种越来越常见的质量改进工具。然而，效果研究的结果却相互矛盾。我们试图了解 ICU 医护人员对核对表的看法，以及在日常查房中有效使用核对表的障碍和促进因素。
了解 ICU 医护人员如何看待查房核对表，并为更有效地实施查房核对表制定框架。
我们在美国一家大型综合医疗系统的 14 家医院的 32 个 ICU 中进行了一项定性研究。我们使用了两种互补的数据收集方法：对日常查房进行直接观察和对 ICU 临床医生进行半结构化访谈。观察和访谈采用主题编码，并使用归纳和演绎相结合的方法确定主要主题。
我们进行了 89 次访谈并进行了 114 小时的观察。在所研究的 ICU 中，有 12 个使用了核对表，20 个没有使用。参与者将查房核对表的目的描述为日常提醒循证实践的工具，用于增加医护人员对患者护理的共同理解的工具，以及提高查房效率的工具。当被视为过度标准化护理时，以及当它们与特定 ICU 的需求不相关时，核对表被认为没有帮助。改善核对表实施的策略包括关注核对表对特定 ICU 的简洁性和相关性、随着时间的推移保持一致的使用，以及与日常工作流程的整合。
我们的研究结果提供了一些关于为什么 ICU 查房核对表经常不能改善结果的潜在见解，并为通过加强反馈和问责制来有效实施核对表提供了一个框架。
