Provider Perceptions Of Rounding Checklists In The Intensive Care Unit

Rounding checklists are increasingly common intensive care unit (ICU) quality improvement tools designed to standardize care, facilitate delivery of evidence-based practice, and prevent errors of omission.Despite their strong conceptual rationale, studies of ICU rounding checklists have shown conflicting results.We sought to understand critical care providers' perceptions of the purpose and value of checklists; as well as barriers and facilitators to effective utilization of checklists during daily rounds.We performed a mixed-methods qualitative study in 32 ICUs within 14 hospitals within the UPMC health care system.Data collection included direct observation of daily rounds and semi-structured interviews which were thematically coded for a priori determined themes and emergent content using NVivo software.We conducted 89 interviews and performed 114 hours of observation.Among study ICUs, 12 (37.5%)used checklists and 20 (62.5%) did not.When present, ICU rounding checklists were not widely adopted and use was inconsistent.Standardization of care and improved communication through the initiation of interprofessional conversation regarding daily goals of care were described by participants as the purpose of rounding checklists.Checklists were perceived as helpful when they were relevant to that particular unit's patient population and were perceived as unhelpful when viewed as "cookie-cutter medicine," restricting clinicians' ability to customize care.Some participants remarked that the v word "checklist" itself has negative connotations related to over-standardization, affecting consistent use, instead proposing more neutral language such as "rounding tool."Respondents identified several practical barriers to use, including time to complete the checklist, lack of followup on checklist use, and resistance to use by one or more rounding team members.We present a framework for effective implementation by creating checklists which: are relevant to the particular unit, ensuring that checklist use is unit-specific rather than provider specific, and emphasizing the importance of achieving buy-in across stakeholders.Our results provide insights about why checklists frequently fail to improve outcomes and offer a framework for effective checklist implementation through more feedback and accountability.Successful implementation of checklists could have far-reaching public health impact due to their potential to reduce costs and loss of life associated with communication and omission errors.vi