(1333) Enhancing Compliance With ICU Rounding Checklists: QI Initiative Within the ICU Liberation Framework

Introduction: The checklist in pediatric intensive care units (PICUs) serves as a critical tool to ensure essential but often overlooked tasks are completed, improving patient outcomes and expediting care de-escalation. It is used as part of the ICU Liberation A-F Bundle framework, which aims to optimize ICU patient recovery and reduce ICU-related complications

Methods: To address low compliance with the checklist, a team identified root causes using fishbone and key driver diagrams, implementing three Plan-Do-Study-Act (PDSA) cycles.

PDSA Cycle 1 (September 2022): The checklist was updated by revising and condensing items, simplifying language, and adding conditional elements to streamline use.
PDSA Cycle 2 (May-June 2023): This cycle focused on enhancing physician and staff engagement by making checklist completion a quality improvement goal.
PDSA Cycle 3 (July 2023): A visual reminder system was implemented by adding a column to the PICU patient list. A red circle next to each patient's name indicated an incomplete checklist, turning green with a checkmark once completed. Providers could access and complete the checklist by clicking on the red circle, eliminating the need to navigate the patient chart. This EHR tool served as both a visual reminder and a tracking mechanism.

The primary outcome was checklist compliance, measured as the proportion of eligible patients with completed checklists daily. Secondary outcomes included PICU length of stay (LOS), hospital LOS, duration of mechanical ventilation, mortality, and PICU readmission rates.

Results: Baseline compliance with checklist completion was low. After PDSA Cycle 1, there was a slight but unsustained improvement. Following PDSA Cycle 2, compliance increased but was not consistently maintained. After PDSA Cycle 3, compliance significantly increased to over 90% and was sustained for more than 10 months, with reduced variation in compliance.

Conclusions: Utilizing quality improvement methodology and integrating electronic health record (EHR) tools significantly enhanced checklist compliance in the PICU. The systematic application of PDSA cycles and the implementation of a visual reminder system were key in improving and sustaining adherence to the ICU Liberation A-F Bundle framework, potentially contributing to better patient outcomes.