College of Medicine, University of Saskatchewan, Regina, SK, Canada.
Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada.
Crit Care Explor. 2024 Aug 20;6(8):e1140. doi: 10.1097/CCE.0000000000001140. eCollection 2024 Aug 1.
To evaluate the effectiveness of ICU rounding checklists on outcomes.
Five electronic databases (MEDLINE, Embase, CINAHL, Cochrane Library, and Google Scholar) were searched from inception to May 10, 2024.
Cohort studies, case-control studies, and randomized controlled trials comparing the use of rounding checklists to no checklists were included. Other article types were excluded.
The primary outcome was in-hospital mortality. Secondary outcomes included ICU and 30-day mortality; hospital and ICU length of stay (LOS); duration of mechanical ventilation; and frequency of catheter-associated urinary tract infections, central line-associated bloodstream infections (CLABSI), and ventilator-associated pneumonia. Additional outcomes included healthcare provider perceptions of checklists.
Pooled estimates were obtained using an inverse-variance random-effects meta-analysis model. Certainty of evidence was evaluated using Grading of Recommendations Assessment, Development, and Evaluation. There were 30 included studies (including > 32,000 patients) in the review. Using an ICU rounding checklist was associated with reduced in-hospital mortality (risk ratio [RR] 0.80; 95% CI, 0.70-0.92; 12 observational studies; 17,269 patients; I2 = 48%; very low certainty of evidence). The use of an ICU rounding checklist was also associated with reduced ICU mortality (8 observational studies, p = 0.006), 30-day mortality (2 observational studies, p < 0.001), hospital LOS (11 observational studies, p = 0.02), catheter-associated urinary tract infections (CAUTI) (6 observational studies, p = 0.01), and CLABSI (6 observational studies, p = 0.02). Otherwise, there were no significant differences with using ICU rounding checklists on other patient-related outcomes. Healthcare providers' perceptions of checklists were generally positive.
The use of an ICU rounding checklist may improve in-hospital mortality, as well as other important patient-related outcomes. However, well-designed randomized studies are necessary to increase the certainty of evidence and determine which elements should be included in an ICU rounding checklist.
评估 ICU 查房核对清单对结局的影响。
从建库到 2024 年 5 月 10 日，检索了 5 个电子数据库（MEDLINE、Embase、CINAHL、Cochrane 图书馆和 Google Scholar）。
纳入了比较使用查房核对清单与不使用核对清单的队列研究、病例对照研究和随机对照试验。排除了其他类型的文章。
主要结局为院内死亡率。次要结局包括 ICU 死亡率和 30 天死亡率；住院和 ICU 住院时间（LOS）；机械通气时间；以及导管相关性尿路感染、中心静脉导管相关性血流感染（CLABSI）和呼吸机相关性肺炎的发生率。其他结局包括医疗保健提供者对核对清单的看法。
使用逆方差随机效应荟萃分析模型获得汇总估计值。使用推荐评估、制定与评价（GRADE）评估证据确定性。综述中纳入了 30 项研究（包括 >32000 例患者）。使用 ICU 查房核对清单与降低院内死亡率相关（风险比 [RR] 0.80；95%置信区间 [CI]，0.70-0.92；12 项观察性研究；17269 例患者；I2=48%；极低确定性证据）。使用 ICU 查房核对清单也与降低 ICU 死亡率（8 项观察性研究，p=0.006）、30 天死亡率（2 项观察性研究，p<0.001）、住院 LOS（11 项观察性研究，p=0.02）、导管相关性尿路感染（CAUTI）（6 项观察性研究，p=0.01）和 CLABSI（6 项观察性研究，p=0.02）相关。否则，使用 ICU 查房核对清单对其他与患者相关的结局没有显著差异。医疗保健提供者对核对清单的看法通常是积极的。
使用 ICU 查房核对清单可能会改善院内死亡率以及其他重要的与患者相关的结局。但是，需要进行精心设计的随机研究以提高证据确定性，并确定 ICU 查房核对清单应包含哪些内容。
