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Background: Communication is a key driver of health care outcomes. Poor communication practices contribute to sentinel safety events, poor family/patient experiences, and delays in care. Use of checklists in the healthcare setting is important to the development of high reliability and is increasingly common, however, the development and implementation of medical checklists for the standard patient floor are inadequately described.

Objective: To develop a sustainable rounding checklist for multidisciplinary discussion of patient safety measures and clinical plans.

Design/Methods: Key stakeholders in the rounding process (subspecialty and general pediatrics physicians, resident physician, bedside nurses, and nursing leadership) created a rounding checklist tool for use on a medical unit at our tertiary care children’s hospital. This checklist was modified from an existing checklist used in the pediatric intensive care unit. It focused on reducing harm, improving quality of care, and facilitating communication. To foster open communication within the multidisciplinary team and project sustainability, bedside nurses owned the task to prompt daily review of checklist items with the team during rounds. We developed badge buddies as an aid and an audit tool to assess checklist compliance. Compliance with checklist use was assessed by iterative Plan-Do-Study-Act (PDSA) cycles. Acceptability and usefulness of the checklist was measured by a 6 month-post implementation survey of nurses, residents, and staff.

Results: A five-item checklist entitled SMART (Situational Awareness, Medications, Access, Routine, and Transition) was created (Figure 1). Daily audits showed between 75%-88% usage of the checklist during rounds (Figure 2). Our first PDSA cycle showed improved compliance with implementation of a streamlined audit tool. 29% of eligible providers completed the survey (n=51). 77% of respondents perceived communication improvement with SMART card usage with 4% disagreement. 66% reported vital patient care details were discussed that would otherwise have been missed. Only 2% found the checklist led to delays in patient care with a majority responding that checklist completion took 30-60 seconds.

Conclusion(s): This project emphasizes the importance of multidisciplinary teams in development and implementation of a daily rounding checklist for a pediatric floor. We demonstrate the feasibility and acceptability of inserting a rounding checklist into the workflow of a multidisciplinary pediatric care team. Further study is needed to determine long-term effects on this initiative on process of care outcomes.

Presented at the 2021 PAS Virtual Conference


Nephrology | Nursing | Pediatrics

A SMARTer Way to Round