智能检查表可提高重症监护病房检查表的依从性：一项前瞻性前后混合方法研究。

Intelligent checklists improve checklist compliance in the intensive care unit: a prospective before-and-after mixed-method study.

机构信息

Department of Internal Medicine, Catharina Hospital Eindhoven, Eindhoven, The Netherlands; Industrial Engineering and Innovation Sciences, Eindhoven University of Technology, Eindhoven, The Netherlands; Department of Intensive Care Unit, Catharina Hospital Eindhoven, Eindhoven, The Netherlands.

出版信息

Br J Anaesth. 2021 Feb;126(2):404-414. doi: 10.1016/j.bja.2020.09.044. Epub 2020 Nov 17.

DOI:10.1016/j.bja.2020.09.044

PMID:33213832

Abstract

BACKGROUND

We examined whether a context and process-sensitive 'intelligent' checklist increases compliance with best practice compared with a paper checklist during intensive care ward rounds.

METHODS

We conducted a single-centre prospective before-and-after mixed-method trial in a 35 bed medical and surgical ICU. Daily ICU ward rounds were observed during two periods of 8 weeks. We compared paper checklists (control) with a dynamic (digital) clinical checklist (DCC, intervention). The primary outcome was compliance with best clinical practice, measured as the percentages of checked items and unchecked critical items. Secondary outcomes included ICU stay and the usability of digital checklists. Data are presented as median (interquartile range).

RESULTS

Clinical characteristics and severity of critical illness were similar during both control and intervention periods of study. A total of 36 clinicians visited 197 patients during 352 ward rounds using the paper checklist, compared with 211 patients during 366 ward rounds using the DCC. Per ICU round, a median of 100% of items (94.4-100.0) were completed by DCC, compared with 75.1% (66.7-86.4) by paper checklist (P=0.03). No critical items remained unchecked by the DCC, compared with 15.4% (8.3-27.3) by the paper checklist (P=0.01). The DCC was associated with reduced ICU stay (1 day [1-3]), compared with the paper checklist (2 days [1-4]; P=0.05). Usability of the DCC was judged by clinicians to require further improvement.

CONCLUSIONS

A digital checklist improved compliance with best clinical practice, compared with a paper checklist, during ward rounds on a mixed ICU.

CLINICAL TRIAL REGISTRATION

NCT03599856.

摘要

背景

我们研究了在重症监护病房查房时，与纸质检查表相比，一种上下文和过程敏感的“智能”检查表是否能提高最佳实践的依从性。

方法

我们在一家 35 张床位的内科和外科重症监护病房进行了一项单中心前瞻性前后混合方法试验。在两个 8 周的时间段内观察每日 ICU 查房。我们将纸质检查表（对照组）与动态（数字）临床检查表（DCC，干预组）进行了比较。主要结局是最佳临床实践的依从性，以检查项目的百分比和未检查的关键项目来衡量。次要结局包括 ICU 住院时间和数字检查表的可用性。数据以中位数（四分位距）表示。

结果

在研究的对照组和干预组期间，临床特征和危重病的严重程度相似。共有 36 名临床医生使用纸质检查表对 197 名患者进行了 352 次查房，而使用 DCC 对 211 名患者进行了 366 次查房。每次 ICU 查房，DCC 完成的项目中位数为 100%（94.4-100.0），而纸质检查表为 75.1%（66.7-86.4）（P=0.03）。DCC 没有未检查的关键项目，而纸质检查表有 15.4%（8.3-27.3）的关键项目未检查（P=0.01）。DCC 与 ICU 住院时间缩短相关（1 天[1-3]），而纸质检查表为 2 天[1-4]；P=0.05）。临床医生认为 DCC 的可用性需要进一步改进。