PT  - JOURNAL ARTICLE
AU  - César E Escamilla-Ocañas
AU  - Gabriel Torrealba-Acosta
AU  - Pitchaiah Mandava
AU  - Muhammad Suhaib Qasim
AU  - Bárbara Gutiérrez-Flores
AU  - Eric Bershad
AU  - Mohammad Hirzallah
AU  - Chethan P Venkatasubba Rao
AU  - Rahul Damani
TI  - Implementation of systematic safety checklists in a neurocritical care unit: a quality improvement study
AID  - 10.1136/bmjoq-2022-001824
DP  - 2022 Dec 01
TA  - BMJ Open Quality
PG  - e001824
VI  - 11
IP  - 4
4099  - http://bmjopenquality.bmj.com/content/11/4/e001824.short
4100  - http://bmjopenquality.bmj.com/content/11/4/e001824.full
SO  - BMJ Open Qual2022 Dec 01; 11
AB  - Background and objectives 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.Design/methods 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.Results 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.Discussion 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.Data are available on reasonable request. Anonymised data as well as the statistical plan and R coding, not published within this article will be made available by request from any investigator.