Quality Improvement Intervention With Daily Round Checklists, Goal Setting, and Clinician Prompting
CHECKLIST-ICU trial design and results
Design
Cluster-randomised clinical trial in 118 ICUs
Treatment
Multifaceted quality improvement intervention with daily round checklists, goal setting and clinician prompting
Control
Routine care
Population
6761 patients in the randomised phase, following 6877 in a baseline observational phase; mean age 59.6
Follow-up
Hospital discharge
Primary endpoint
In-hospital mortality
Result
3327 patients were in 59 ICUs assigned to the intervention and 3434 in 59 ICUs assigned to routine care. There was no significant difference in in-hospital mortality between the groups.
Secondary endpoints
Adherence to care processes, ICU length of stay, ventilator-free days, central line infections
Among critically ill patients treated in ICUs in Brazil, implementation of a multifaceted quality improvement intervention with daily checklists, goal setting, and clinician prompting did not reduce in-hospital mortality.
The trial authors, in the published abstract
How it has aged
A sobering counterweight to the uncontrolled before-and-after successes that made checklists ubiquitous, such as Keystone ICU. When the same idea is cluster-randomised against concurrent controls, the mortality benefit disappears — which suggests secular improvement rather than the checklist did the earlier work.
Publications
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
Cavalcanti AB, Bozza FA, Machado FR, et al. 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. JAMA 2016 Apr 12;315(14):1480-90.
No significant difference in in-hospital mortality
Cluster-randomised across 118 ICUs with concurrent controls