Abstract Details

Title Implementation of systematic safety checklists in a Neurointensive Care Unit: A quality and improvement study.

Topic Neurocritical Care

Presentation(s) S21 - Neurocritical Care (2:36 PM-2:48 PM)

Poster/Presentation
Number 009

Background

When managing critically ill brain-injured patients, a daily systematic and organized approach is essential. Structured and systematized checklists have shown to prevent complications and to improve patient care.

Objective

To evaluate the implementation of systematic safety checklists in the Neurointensive Care Unit (NICU) at Baylor St. Luke’s Medical Center (BSLMC).

Design/Methods

This was a quality improvement project that followed a Plan-Do-Study-Act methodology. A checklist including medication reconciliation, thromboembolic prophylaxis, glycemic control, daily breathing trial, diet, catheter/lines duration monitoring and antibiotics de-escalation; was implemented during daily patient rounds. Main outcomes assessed included rate of new infections, mortality and NICU length-of-stay (LOS). Intervened subjects were compared to historical controls after propensity score and Euclidean distance matching to balance baseline covariates.

Results We applied checklists on 411 patients; overall average age was 61.34±17.39. Main reason for admission included tumor resection (31.39%), ischemic stroke (26.76%) and intracranial hemorrhage (10.95%), mean Sequential Organ Failure Assessment (SOFA) score was 2.58±2.68. After controlling for SOFA, age, gender and primary admitting diagnosis, the implementation of systematic checklists significantly correlated with reduced LOS (ß=-0.15, 95% CI: -0.24–-0.06, p=<0.001), reduced rate of any new infection (OR: 0.59, 95% CI: 0.40–0.87), p=0.008) and reduced UTI (OR: 0.23, 95% CI: 0.09–0.55, p=0.001). Propensity score and Euclidean distance matching yielded 382 and 338 pairs, respectively, with excellent covariate balance; outcomes remained significant after matching. At the end of the study, the checklist compliance rate throughout the full patient’s stay, reached 97.11%.

Conclusions

Our intervention resulted in a reduced NICU-LOS, rate of new infections and rate of UTIs compared to propensity score and Euclidean distance matched historical controls. The implementation of daily rounding safety checklists in the NICU proved to be feasible, easy to implement and a helpful tool to improve adherence to practice guidelines and quality of care measurements.

Authors/Disclosures
Gabriel Torrealba Acosta, MD (Duke University Hospital Neurocritical Care Unit) PRESENTER	Dr. Torrealba Acosta has nothing to disclose.
Cesar E. Escamilla-Ocanas, MD	Dr. Escamilla-Ocanas has nothing to disclose.
Pitchaiah Mandava, MD, PhD	Dr. Mandava has nothing to disclose.
Eric Bershad, MD (Baylor College of Medicine)	Dr. Bershad has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Various.
Mohammad I. Hirzallah, MD (Baylor College of Medicine)	Dr. Hirzallah has nothing to disclose.
Chethan P. Venkatasubba Rao, MD (Baylor College of Medicine)	Dr. Venkatasubba Rao has received personal compensation in the range of $0-$499 for serving as an officer or member of the Board of Directors for Maestro Inc.
	No disclosure on file
Rahul Damani	No disclosure on file