Ward Rounds

A new Northwestern Medicine™ study shows that mortality rates dropped 50 percent and ICU stays were decreased by more than a day when the attending physician in the intensive care unit had a checklist – a fairly new concept in medicine – and a trusted person prompting him to address issues on the list if they were being overlooked.

Curtis Weiss, MD, the lead investigator and a fellow in pulmonary and critical care medicine at Northwestern University Feinberg School of Medicine, conducted the study in the medical intensive care unit at Northwestern Memorial Hospital. It was published online in the American Journal of Respiratory and Critical Care Medicine.

The checklist included six important parameters often passed over such as testing whether a patient can be taken off a ventilator and the duration of empiric antibiotics and central venous catheters.

One team of physicians had face-to-face, frequent prompting by a resident physician to address issues on the checklist, only if the issues were overlooked during daily rounds. The other team continued to use the checklist without prompting.

“We didn’t mandate that they had to change their management; it was nuanced,” Weiss said. “It was ‘do you plan to continue the antibiotics today?’ not ‘you should stop the antibiotics.’“

Weiss concedes hospitals aren’t likely to hire physicians just to be prompters. But perhaps nurses or even an electronic version of the verbal prompting could be equally effective, he said.

Northwestern is a leader in this new area of research and is actively investigating alternatives such as an electronic checklist in its intensive care units that follow the same principles Weiss employed.