(Screen 3 - 6:00 PM Friday) Impact of a Daily Intensive Care Unit Checklist on Patient Outcomes in a mixed Pediatric Intensive Care Unit/Pediatric Cardiac Intensive Care Unit

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Abstract: Intro/

Objective: As hospital outcome reporting is directly associated with payer reimbursement, decreasing hospital acquired infections (HAI) is essential. An intensive care unit (ICU) environment is fast paced and stressful leading to prolonged duration of indwelling medical devices as well as missed opportunities to de-intensify the patient both of which impact length of stay (LOS), HAI, and overall patient outcomes. Daily ICU bedside rounds present opportunities for all disciplines to engage and impact patient care. The purpose of this quality improvement (QI) project was to implement a daily ICU safety checklist in the electronic medical record (Figure 1) for every patient following rounds and assess impact on LOS, central line days and the rate of central line associated blood stream infections (CLABSI) in a mixed pediatric intensive care unit (PICU) and pediatric cardiac intensive care unit (PCICU) of a tertiary care academic hospital.

Methods: Central line days and CLABSI rate were obtained from the institutional QI database through Virtual PICU Systems (VPS) from July 2012 to August 2021. A descriptive analysis before and after implementation of the ICU safety checklist on July 1, 2017 was conducted. We evaluated differences between central line days before and after implementation using the Wilcoxon rank-sum test with p < 0.05 considered significant. Data on ICU safety checklist usage was collected via EPIC reports and available from November 2020 to April 2022. The association between rate of ICU safety checklist usage and LOS was modeled using simple linear regression.

Results: There were a total of 1070 central lines from July 2012 to August 2021 with 388 pre-implementation. Median central line days pre- and post ICU safety checklist implementation were not significantly different (4.6 vs 5.2 days, p = 0.06). CLABSI rates decreased from 5.35 infections per 1000 central line days pre-implementation to 3.56 post-implementation. From November 2020 to April 2022, the ICU safety checklist was utilized daily per patient an average of 63.8% of the time. There was a trend towards decreased average LOS per patient per month with increasing proportion of ICU safety checklist usage but was not statistically significant (β = -43.9; -91.2 – 3.43, p = 0.067).

Conclusions: Utilizing the ICU safety checklist during rounds facilitates a multidisciplinary approach to the patients’ care ensuring discussion of QI initiatives as well as ICU morbidity and LOS contributors. The ICU safety checklist was utilized most patient days and while not statistically significant, we found a trend towards shorter LOS with increased daily use. There was also a reduction in CLABSI rates after implementation, however, the effect of simultaneous projects to address device-related infections cannot be excluded. Further analysis including risk adjustment, review of arterial line days, foley days, and catheter associated urinary tract infections will be conducted.