Abstract：
Structured and systematised checklists have been shown to prevent complications and improve patient care. We evaluated the implementation of systematic safety checklists in our neurocritical care unit (NCCU) and assessed its effect on patient outcomes.
This quality improvement project followed a Plan-Do-Study-Act (PDSA) methodology. A checklist for medication reconciliation, thromboembolic prophylaxis, glycaemic control, daily spontaneous awakening, breathing trial, diet, catheter/lines duration monitoring and antibiotics de-escalation was implemented during daily patient rounds. Main outcomes included the rate of new infections, mortality and NCCU-length of stay (LOS). Intervened patients were compared with historical controls after propensity score and Euclidean distance matching to balance baseline covariates.
After several PDSA iterations, we applied checklists to 411 patients; the overall average age was 61.34 (17.39). The main reason for admission included tumour resection (31.39%), ischaemic stroke (26.76%) and intracerebral haemorrhage (10.95%); the mean Sequential Organ Failure Assessment (SOFA) score was 2.58 (2.68). At the end of the study, the checklist compliance rate throughout the full NCCU stays reached 97.11%. After controlling for SOFA score, age, sex and primary admitting diagnosis, the implementation of systematic checklists significantly correlated with a reduced LOS (ß=-0.15, 95% CI -0.24 to -0.06), reduced rate of any new infections (OR 0.59, 95% CI 0.40 to 0.87) and reduced urinary tract infections (UTIs) (OR 0.23, 95% CI 0.09 to 0.55). Propensity score and Euclidean distance matching yielded 382 and 338 pairs with excellent covariate balance. After matching, outcomes remained significant.
The implementation of safety checklists in the NCCU proved feasible, easy to incorporate into the NCCU workflow, and a helpful tool to improve adherence to practice guidelines and quality of care measurements. Furthermore, our intervention resulted in a reduced NCCU-LOS, rate of new infections and rate of UTIs compared with propensity score and Euclidean distance matched historical controls.
This quality improvement project followed a Plan-Do-Study-Act (PDSA) methodology. A checklist for medication reconciliation, thromboembolic prophylaxis, glycaemic control, daily spontaneous awakening, breathing trial, diet, catheter/lines duration monitoring and antibiotics de-escalation was implemented during daily patient rounds. Main outcomes included the rate of new infections, mortality and NCCU-length of stay (LOS). Intervened patients were compared with historical controls after propensity score and Euclidean distance matching to balance baseline covariates.
After several PDSA iterations, we applied checklists to 411 patients; the overall average age was 61.34 (17.39). The main reason for admission included tumour resection (31.39%), ischaemic stroke (26.76%) and intracerebral haemorrhage (10.95%); the mean Sequential Organ Failure Assessment (SOFA) score was 2.58 (2.68). At the end of the study, the checklist compliance rate throughout the full NCCU stays reached 97.11%. After controlling for SOFA score, age, sex and primary admitting diagnosis, the implementation of systematic checklists significantly correlated with a reduced LOS (ß=-0.15, 95% CI -0.24 to -0.06), reduced rate of any new infections (OR 0.59, 95% CI 0.40 to 0.87) and reduced urinary tract infections (UTIs) (OR 0.23, 95% CI 0.09 to 0.55). Propensity score and Euclidean distance matching yielded 382 and 338 pairs with excellent covariate balance. After matching, outcomes remained significant.
The implementation of safety checklists in the NCCU proved feasible, easy to incorporate into the NCCU workflow, and a helpful tool to improve adherence to practice guidelines and quality of care measurements. Furthermore, our intervention resulted in a reduced NCCU-LOS, rate of new infections and rate of UTIs compared with propensity score and Euclidean distance matched historical controls.
摘要：
目的：结构化和系统化的检查表已被证明可以预防并发症并改善患者护理。我们评估了神经重症监护病房（NCCU）中系统安全检查表的实施情况，并评估了其对患者预后的影响。
方法：此质量改进项目遵循计划-做-研究-行动（PDSA）方法。药物和解检查表，血栓栓塞预防，血糖控制，每天自发觉醒，呼吸试验,饮食，在每日患者查房期间实施导管/管路持续时间监测和抗生素降阶梯.主要结果包括新感染率，死亡率和NCCU-住院时间（LOS）。在倾向评分和欧氏距离匹配以平衡基线协变量后，将干预患者与历史对照进行比较。
结果：经过多次PDSA迭代，我们对411例患者应用检查表;总体平均年龄为61.34岁(17.39岁).入院的主要原因包括肿瘤切除（31.39%），缺血性卒中（26.76％）和脑出血（10.95％）；平均序贯器官衰竭评估（SOFA）评分为2.58（2.68）。在研究结束时,整个NCCU停留期间的检查表合规率达到97.11%。控制SOFA评分后，年龄,性别和主要入院诊断，系统检查表的实施与LOS降低显著相关(β=-0.15，95%CI-0.24至-0.06)，任何新感染的发生率降低（OR0.59，95％CI0.40至0.87），尿路感染（UTI）减少（OR0.23，95％CI0.09至0.55）。倾向得分和欧几里得距离匹配产生了382和338对，具有出色的协变量平衡。匹配后,结果仍然很重要。
结论：在NCCU中实施安全检查表证明是可行的，易于纳入NCCU工作流程，和一个有用的工具，以提高坚持实践指南和护理质量的测量。此外，我们的干预导致NCCU-LOS降低，与倾向评分和欧几里德距离匹配的历史对照相比，新感染率和UTI发生率。
方法：此质量改进项目遵循计划-做-研究-行动（PDSA）方法。药物和解检查表，血栓栓塞预防，血糖控制，每天自发觉醒，呼吸试验,饮食，在每日患者查房期间实施导管/管路持续时间监测和抗生素降阶梯.主要结果包括新感染率，死亡率和NCCU-住院时间（LOS）。在倾向评分和欧氏距离匹配以平衡基线协变量后，将干预患者与历史对照进行比较。
结果：经过多次PDSA迭代，我们对411例患者应用检查表;总体平均年龄为61.34岁(17.39岁).入院的主要原因包括肿瘤切除（31.39%），缺血性卒中（26.76％）和脑出血（10.95％）；平均序贯器官衰竭评估（SOFA）评分为2.58（2.68）。在研究结束时,整个NCCU停留期间的检查表合规率达到97.11%。控制SOFA评分后，年龄,性别和主要入院诊断，系统检查表的实施与LOS降低显著相关(β=-0.15，95%CI-0.24至-0.06)，任何新感染的发生率降低（OR0.59，95％CI0.40至0.87），尿路感染（UTI）减少（OR0.23，95％CI0.09至0.55）。倾向得分和欧几里得距离匹配产生了382和338对，具有出色的协变量平衡。匹配后,结果仍然很重要。
结论：在NCCU中实施安全检查表证明是可行的，易于纳入NCCU工作流程，和一个有用的工具，以提高坚持实践指南和护理质量的测量。此外，我们的干预导致NCCU-LOS降低，与倾向评分和欧几里德距离匹配的历史对照相比，新感染率和UTI发生率。
