Measurable Outcomes of Quality Improvement in the Trauma Intensive Care Unit: The Impact of a Daily Quality Rounding Checklist

• DOI: 10.1097/ta.0b013e318161b0c8
• Publication Date: 2009-03-05T05:53:51Z
• Authors: Joseph J. DuBose; Kenji Inaba; Anthony Shiflett; Christine Trankiem; Pedro G. R. Teixeira; Ali Salim; Peter Rhee; Demetrios Demetri...; Howard Belzberg
• Keywords: Ventilator-associated Pneumonia

Objective: The use of "care bundles" in the prevention ventilator-associated pneumonia (VAP) and other intensive care unit (ICU) complications have been increasingly used critical practice. However, effective implementation these strategies represents a challenge busy Level I trauma ICU. We devised daily "Quality Rounds Checklist" (QRC) tool for ICU to increase compliance with prophylactic measures identify areas improvement quality care. Methods: A prospective before-after design was examine effectiveness QRC promoting 16 VAP, deep venous thrombosis or pulmonary embolism, central line infection complications. Compliance assessed 1 month before institution QRC. On analysis, then applied by fellow assess compliance. Any deficiencies were actively corrected real time. multidisciplinary team next 3 months compared pre-QRC rates. Results: Implementation facilitated all not already at >95% VAP head bed elevation >30 degrees (35.2% vs. 84.5%), sedation holiday (78.0% 86.0%), prophylaxis both peptic ulcer disease (76.2% 92.3%) (91.4% 92.8%) increased. decrease duration >72 hours (62.4% 52.8%) ventilator (74.0% 61.7%) also noted. Additionally, mean monthly rates per 1,000 device days (16.3 8.9), (11.3 5.8) self-extubation (7.8 2.2) demonstrated. Conclusion: Introducing improved clinically significant this tool, requiring just few minutes patient complete, results sustainable outcomes.