Clark Nicholas A, Burrus Stephanie, Richardson Troy, Sterner Sophia, Queen Mary Ann
Children's Mercy Kansas City, Kansas City, Missouri; and
Children's Mercy Kansas City, Kansas City, Missouri; and.
Hosp Pediatr. 2019 Apr;9(4):291-299. doi: 10.1542/hpeds.2018-0150.
Checklists have been found to improve patient outcomes in a variety of health care settings, but use is rare during general pediatric rounds. We aimed to decrease length of stay (LOS) by 10% within 12 months through the standardized delivery of 8 aspects of hospital care for the general pediatric unit.
For the general pediatrics unit at our freestanding children's hospital, a clinical rounding checklist was developed through a consensus of teaching faculty. Iterative plan-do-study-act cycles were conducted in a targeted medical unit over a 12-month period. We assessed change using control charts.
Checklist use increased from 61% to 96% early in the implementation phase. LOS (72 hours) was relatively unchanged. Cardiorespiratory monitor (CRM) duration was reduced by 28% (17.3 hours) within 4 months and was sustained for more than 12 months. A similar CRM reduction of 29% (22.5 hours) was seen in our medically complex patient subgroup. No clinically significant change was appreciated in central line, peripheral intravenous (IV) catheter, IV fluid, or IV medication duration. Thirty-day readmissions, code blue events, and rapid response team activations were not impacted.
The use of a clinical rounding checklist on the general pediatric floor improved care in only 1 of 8 targeted domains. LOS did not change significantly over the project's duration. CRM duration was significantly reduced in both routine patients and medically complex children, and these improvements were sustained without impacting patient safety. More study is needed to determine which checklist components, if any, may prove beneficial to patient outcomes.
研究发现，检查表可改善各种医疗环境中的患者治疗效果，但在普通儿科查房期间使用较少。我们旨在通过对普通儿科病房的8个方面的医院护理进行标准化提供，在12个月内将住院时间（LOS）缩短10%。
对于我们独立儿童医院的普通儿科病房，通过教学人员的共识制定了临床查房检查表。在一个目标医疗单元中进行了为期12个月的迭代计划-实施-研究-改进循环。我们使用控制图评估变化。
在实施阶段早期，检查表的使用从61%增加到96%。住院时间（72小时）相对未变。心肺监测仪（CRM）的使用时长在4个月内减少了28%（17.3小时），并持续了超过12个月。在病情复杂的患者亚组中，CRM使用时长也有类似的29%（22.5小时）的减少。中心静脉导管、外周静脉（IV）导管、IV液体或IV药物使用时长没有明显的临床显著变化。30天再入院率、蓝色代码事件和快速反应团队激活情况未受影响。
在普通儿科病房使用临床查房检查表仅在8个目标领域中的1个改善了护理。在项目期间，住院时间没有显著变化。常规患者和病情复杂儿童的CRM使用时长均显著减少，并且这些改善得以持续，同时未影响患者安全。需要更多研究来确定检查表的哪些组成部分（如果有的话）可能对患者治疗效果有益。
