Impact of Rounding Checklists on the Outcomes of Patients Admitted to ICUs: A Systematic Review and Meta-Analysis.

Q4 Medicine Critical care explorations Pub Date : 2024-08-20 eCollection Date: 2024-08-01 DOI:10.1097/CCE.0000000000001140
Khrystia M MacKinnon, Samuel Seshadri, Jonathan F Mailman, Eric Sy
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Abstract

Objectives: To evaluate the effectiveness of ICU rounding checklists on outcomes.

Data sources: Five electronic databases (MEDLINE, Embase, CINAHL, Cochrane Library, and Google Scholar) were searched from inception to May 10, 2024.

Study selection: Cohort studies, case-control studies, and randomized controlled trials comparing the use of rounding checklists to no checklists were included. Other article types were excluded.

Data extraction: The primary outcome was in-hospital mortality. Secondary outcomes included ICU and 30-day mortality; hospital and ICU length of stay (LOS); duration of mechanical ventilation; and frequency of catheter-associated urinary tract infections, central line-associated bloodstream infections (CLABSI), and ventilator-associated pneumonia. Additional outcomes included healthcare provider perceptions of checklists.

Data synthesis: Pooled estimates were obtained using an inverse-variance random-effects meta-analysis model. Certainty of evidence was evaluated using Grading of Recommendations Assessment, Development, and Evaluation. There were 30 included studies (including > 32,000 patients) in the review. Using an ICU rounding checklist was associated with reduced in-hospital mortality (risk ratio [RR] 0.80; 95% CI, 0.70-0.92; 12 observational studies; 17,269 patients; I2 = 48%; very low certainty of evidence). The use of an ICU rounding checklist was also associated with reduced ICU mortality (8 observational studies, p = 0.006), 30-day mortality (2 observational studies, p < 0.001), hospital LOS (11 observational studies, p = 0.02), catheter-associated urinary tract infections (CAUTI) (6 observational studies, p = 0.01), and CLABSI (6 observational studies, p = 0.02). Otherwise, there were no significant differences with using ICU rounding checklists on other patient-related outcomes. Healthcare providers' perceptions of checklists were generally positive.

Conclusions: The use of an ICU rounding checklist may improve in-hospital mortality, as well as other important patient-related outcomes. However, well-designed randomized studies are necessary to increase the certainty of evidence and determine which elements should be included in an ICU rounding checklist.

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查房清单对重症监护室入院患者治疗结果的影响:系统回顾与元分析》。
目的评估重症监护室查房清单对疗效的影响:检索了从开始到 2024 年 5 月 10 日的五个电子数据库(MEDLINE、Embase、CINAHL、Cochrane Library 和 Google Scholar):包括队列研究、病例对照研究和比较使用查房清单与不使用查房清单的随机对照试验。数据提取:主要结果为院内死亡率。次要结果包括重症监护室和 30 天死亡率;住院时间和重症监护室住院时间(LOS);机械通气时间;导管相关性尿路感染、中心静脉相关性血流感染(CLABSI)和呼吸机相关性肺炎的发生频率。其他结果包括医护人员对核对表的看法:采用反方差随机效应荟萃分析模型得出汇总估计值。证据的确定性采用建议分级评估、发展和评价法进行评价。综述共纳入 30 项研究(包括超过 32,000 名患者)。使用重症监护室查房清单与院内死亡率降低有关(风险比 [RR] 0.80;95% CI,0.70-0.92;12 项观察性研究;17269 名患者;I2 = 48%;证据确定性极低)。ICU 查房清单的使用还与 ICU 死亡率(8 项观察性研究,P = 0.006)、30 天死亡率(2 项观察性研究,P < 0.001)、住院时间(11 项观察性研究,P = 0.02)、导管相关性尿路感染(CAUTI)(6 项观察性研究,P = 0.01)和 CLABSI(6 项观察性研究,P = 0.02)的降低有关。除此之外,使用 ICU 查房清单对其他患者相关结果的影响没有明显差异。医护人员对核对表的看法普遍积极:结论:使用重症监护室查房清单可能会改善院内死亡率以及其他重要的患者相关结果。然而,有必要进行设计良好的随机研究,以增加证据的确定性,并确定 ICU 查房核对表应包含哪些内容。
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