Effect of Compliance With a Nurse-Led Intensive Care Unit Checklist on Clinical Outcomes in Mechanically and Nonmechanically Ventilated Patients

Abstract

Background: Use of checklists brings about improvements in a variety of patient outcomes. Nevertheless, whether compliance with a nurse-led intensive care unit (ICU) checklist produces the same effect is currently unknown.

Methods: This is a retrospective analysis of data obtained during the implementation of a quality improvement project consisting of the utilization of a nurse-led ICU checklist. A consecutive series of checklists obtained from patients admitted in our ICU during 7 consecutive months were included. The ICU stay, hospital stay, and ventilator stay were compared between patients whose practitioners completed or did not complete the checklist. Variables were analyzed using Mann-Whitney U tests for continuous variables and Fisher exact tests for categorical variables. A 2-tailed P < .05 was considered statistically significant.

Results: One thousand checklists, corresponding to 346 eligible patients, were collected over 7 months. Mechanical ventilation was used in 203 (59%) patients. Completed checklists were observed for 37.6% (n = 130) of all patients and 38.9% (n = 79) of mechanically ventilated patients. After adjusting for age, Acute Physiology and Chronic Health Evaluation II (APACHE II), body mass index, reason for admission, and type of ICU, completion of the checklist was associated with a 20% increase in the number of days in the ICU compared with the group with incomplete lists. In mechanically ventilated patients, completion of the checklist was associated with a 31% increase in hospital length of stay, a 34% increase in the number of ICU days, and a 32% increase in mechanical ventilation days.

Conclusion: Compliance with completion of a nurse-led ICU checklist was associated with prolonged ICU stay, hospital stay, and ventilator stay.

Keywords: checklist; quality; safety.