Prompting physicians to address a daily checklist and process of care and clinical outcomes: A single-site study

Curtis H. Weiss, Farzad Moazed, Colleen A. McEvoy, Benjamin D. Singer, Igal Szleifer, Luís A.N. Amaral, Mary Kwasny, Charles M. Watts, Stephen D. Persell, David W. Baker, Jacob I. Sznajder, Richard G. Wunderink

Research output: Contribution to journalArticlepeer-review

142 Scopus citations


Rationale: Checklists may reduce errors of omission for critically ill patients. Objectives: To determine whether prompting to use a checklist improves process of care and clinical outcomes. Methods: We conducted a cohort study in the medical intensive care unit (MICU) of a tertiary care university hospital. Patients admitted to either of two independent MICU teams were included. Intervention team physicians were prompted to address six parameters from a daily rounding checklist if overlooked during morning work rounds. The second team (control) used the identical checklist without prompting. Measurements and Main Results: One hundred and forty prompted group patients were compared with 125 control and 1,283 preintervention patients. Compared with control, prompting increased median ventilator-free duration, decreased empirical antibiotic and central venous catheter duration, and increased rates of deep vein thrombosis and stress ulcer prophylaxis. Prompted group patients had lower risk-adjusted ICU mortality compared with the control group (odds ratio, 0.36; 95% confidence interval, 0.13-0.96; P = 0.041) and lower hospital mortality compared with the control group (10.0 vs. 20.8%; P = 0.014), which remained significant after risk adjustment (odds ratio, 0.34; 95% confidence interval, 0.15-0.76; P = 0.008). Observed-to-predicted ICU length of stay was lower in the prompted group compared with control (0.59 vs. 0.87;P = 0.02). Checklist availability alone did not improve mortality or length of stay compared with preintervention patients. Conclusions: In this single-site, preliminary study, checklist-based prompting improved multiple processes of care, and may have improved mortality and length of stay, compared with a stand-alone checklist. The mannerin which checklists are implementedis of great consequence in the care of critically ill patients.

Original languageEnglish
Pages (from-to)680-686
Number of pages7
JournalAmerican journal of respiratory and critical care medicine
Issue number6
StatePublished - Sep 15 2011


  • Critical care
  • Outcome and process assessment
  • Quality improvement


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