Research Activities, November-December 2013
Checklist boosts clinician adherence to quality care for conditions common in hospitalized general medicine patients
Patient Safety and Quality
A checklist that requires providers to address the four most common and expensive-to-treat health care-associated conditions observed in hospitalized general medicine patients boosts adherence to appropriate care processes, according to a new study.
Checklists, used to improve safety in other industries such as aviation, have recently been introduced into hospital care, resulting in reduced complications among surgery and intensive care unit patients. Checklist developers have identified up to 30 quality indicators related to general hospital care, resulting in variable rates of adherence to many of these measures.
In this study, the researchers limited the checklist to care measures for four common, easily prevented problems with substantial financial impact:
- Pneumococcal immunization (I).
- Pressure ulcers/bedsores (B).
- Catheter-associated urinary tract infections or CAUTIs (C).
- Deep venous thrombosis/venous thromboembolism or DVT/VTE (D).
They had attending physicians fill out the IBCD checklist once per patient, as part of the post-call morning rounds for new admissions.
Immunization with pneumococcal polysaccharide vaccine can prevent half of hospital deaths from pneumococcal infections and 15–24 percent of hospital patients develop bedsores (at a treatment cost of $2.2–3.4 billion annually). CAUTIs are responsible for some 40 percent of hospital-associated infections, while DVT/VTEs are the commonest reason for death in hospitals (occurring in up to 60 percent of patients in the absence of preventive care). In a large urban medical center, 66 general medicine teams (70 percent) voluntarily used the IBCD checklist for 1,168 of new patients during the 9-month study period. Average adherence to the four checklist items rose significantly, from 68 percent on admission to 82 percent after checklist use.
In the 6 weeks after the checklist was transitioned to the electronic medical record, IBCD was noted in documentation of 59 percent of patients admitted to general medicine. This study was funded in part by AHRQ (HS16967) to the University of Chicago Center for Education and Research on Therapeutics (CERT). For more information on the CERTs program, visit http://www.certs.hhs.gov.
More details are in "IBCD: Development and testing of a checklist to improve quality of care for hospitalized general medicine patients," by Andrew M. Davis, M.D., M.P.H., Elizabeth M. Schulwolf, M.D., M.A., Valerie G. Press, M.D., M.P.H., Vineet M. Arora, M.D., M.P.P, and others in the April 2013 The Joint Commission Journal on Quality and Patient Safety 39(4), pp. 147-156.