Implementation of a General Pediatric Clinical Rounding Checklist.
Document Type
Article
Publication Date
4-2019
Identifier
DOI: 10.1542/hpeds.2018-0150
Abstract
BACKGROUND: Checklists have been found to improve patient outcomes in a variety of health care settings, but use is rare during general pediatric rounds. We aimed to decrease length of stay (LOS) by 10% within 12 months through the standardized delivery of 8 aspects of hospital care for the general pediatric unit.
METHODS: For the general pediatrics unit at our freestanding children's hospital, a clinical rounding checklist was developed through a consensus of teaching faculty. Iterative plan-do-study-act cycles were conducted in a targeted medical unit over a 12-month period. We assessed change using control charts.
RESULTS: Checklist use increased from 61% to 96% early in the implementation phase. LOS (72 hours) was relatively unchanged. Cardiorespiratory monitor (CRM) duration was reduced by 28% (17.3 hours) within 4 months and was sustained for more than 12 months. A similar CRM reduction of 29% (22.5 hours) was seen in our medically complex patient subgroup. No clinically significant change was appreciated in central line, peripheral intravenous (IV) catheter, IV fluid, or IV medication duration. Thirty-day readmissions, code blue events, and rapid response team activations were not impacted.
CONCLUSIONS: The use of a clinical rounding checklist on the general pediatric floor improved care in only 1 of 8 targeted domains. LOS did not change significantly over the project's duration. CRM duration was significantly reduced in both routine patients and medically complex children, and these improvements were sustained without impacting patient safety. More study is needed to determine which checklist components, if any, may prove beneficial to patient outcomes.
Journal Title
Hosp Pediatr
Volume
9
Issue
4
First Page
291
Last Page
299
MeSH Keywords
Checklist; Child; Continuity of Patient Care; Efficiency, Organizational; Humans; Intensive Care Units, Pediatric; Length of Stay; Patient Care Team; Process Assessment, Health Care; Quality Improvement; Teaching Rounds
Keywords
Checklist; Child; Continuity of Patient Care; Efficiency, Organizational; Humans; Intensive Care Units, Pediatric; Length of Stay; Patient Care Team; Process Assessment, Health Care; Quality Improvement; Teaching Rounds
Recommended Citation
Clark NA, Burrus S, Richardson T, Sterner S, Queen MA. Implementation of a General Pediatric Clinical Rounding Checklist. Hosp Pediatr. 2019;9(4):291-299. doi:10.1542/hpeds.2018-0150
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