Effect of a Quality Improvement Intervention With Daily Round Checklists, Goal Setting, and Clinician Prompting on Mortality of Critically Ill Patients: A Randomized Clinical Trial

摘要: Importance The effectiveness of checklists, daily goal assessments, and clinician prompts as quality improvement interventions in intensive care units (ICUs) is uncertain. Objective To determine whether a multifaceted intervention reduces the mortality critically ill adults. Design, Setting, Participants This study had 2 phases. Phase 1 was an observational to assess baseline data on work climate, processes, clinical outcomes, conducted between August 2013 March 2014 118 Brazilian ICUs. cluster randomized trial April November with same first 60 admissions longer than 48 hours per ICU were enrolled each phase. Interventions Intensive intervention, including checklist setting during multidisciplinary rounds follow-up prompting for 11 or routine care. Main Outcomes Measures In-hospital truncated at days (primary outcome) analyzed using random-effects logistic regression model, adjusted patients’ severity ICU’s standardized ratio. Exploratory secondary outcomes included adherence safety events. Results A total 6877 patients (mean age, 59.7 years; 3218 [46.8%] women) (observational) phase 6761 59.6 3098 [45.8%] phase, 3327 ICUs (n = 59) assigned group 3434 There no significant difference in-hospital usual group, 1096 deaths (32.9%) 1196 (34.8%), respectively (odds ratio, 1.02; 95% CI, 0.82-1.26; P  = .88). Among 20 prespecified not multiple comparisons, 6 significantly improved (use low tidal volumes, avoidance heavy sedation, use central venous catheters, urinary perception team work, patient climate), whereas there differences control 14 (ICU mortality, line–associated bloodstream infection, ventilator-associated pneumonia, tract mean ventilator-free days, length stay, hospital bed elevation ≥30°, thromboembolism prophylaxis, diet administration, job satisfaction, stress reduction, management, working conditions). Conclusions Relevance treated Brazil, implementation setting, did reduce mortality. Trial Registration clinicaltrials.gov Identifier:NCT01785966