You could be reading the full-text of this article now if you...

If you have access to this article through your institution,
you can view this article in

Use of a Daily Goals Checklist for Morning ICU Rounds: A Mixed-Methods Study*

Centofanti, John Eugenio MD1; Duan, Erick H. MD2; Hoad, Neala C. RN3; Swinton, Marilyn E. BA4; Perri, Dan MD2,3; Waugh, Lily RN3; Cook, Deborah J. MD2–4

Critical Care Medicine:
doi: 10.1097/CCM.0000000000000331
Clinical Investigations
Abstract

Objective: To understand the perspectives and attitudes of ICU clinicians about use of a daily goals checklist on rounds.

Design: Our three data collection methods were as follows: 1) Field observations: two investigators conducted field observations to understand how and by whom the daily goals checklist was used for 80 ICU patient rounds over 6 days. 2) Document analysis: The 72 completed daily goals checklists from observed rounds were analyzed using mixed methods. 3) Interviews: With 56 clinicians, we conducted semistructured individual and focus-group interviews, analyzing transcripts using a qualitative descriptive approach and content analysis. Triangulation was achieved by a multidisciplinary investigative team using two research methods and three data sources.

Setting: Fifteen bed closed ICU in a tertiary care, university-affiliated hospital.

Patients: Medical-surgical ICU patients.

Interventions: None.

Measurements and Main Results: Field observations: The daily goals checklist was completed for 93% of observed rounds, largely by residents (86%). The champion of the verbal review was commonly a resident (83%) or medical student (9%). Document analysis: Domains with high completion rates included ventilation, sedation, central venous access, nutrition, and various prophylactic interventions. Interviews: The daily goals checklist enhanced communication, patient care, and education. Nurses, physicians, and pharmacists endorsed its enhancement of interdisciplinary communication. It facilitated a structured, thorough, and individualized approach to patient care. The daily goals checklist helped to identify new patient care issues and sparked management discussions, especially for sedation, weaning, and medications. Residents were prominent users, finding served as a multipurpose teaching tool.

Conclusions: The daily goals checklist was perceived to improve the management of critically ill patients by creating a systematic, comprehensive approach to patient care and by setting individualized daily goals. Reportedly improving interprofessional communication and practice, the daily goals checklist also enhanced patient safety and daily progress, encouraging momentum in recovery from critical illness. Daily goals checklist review prompted teaching opportunities for multidisciplinary learners on morning rounds.

Author Information

1Department of Anesthesia, McMaster University, Hamilton, ON, Canada.

2Department of Medicine, McMaster University, Hamilton, ON, Canada.

3Department of Critical Care, St Joseph’s Healthcare, Hamilton, ON, Canada.

4Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.

* See also p. 1940.

Drs. Centofanti and Duan are co-principal investigators.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).

Dr. Centofanti received support for travel from Physicians’ Services Incorporated Foundation and Hamilton Regional Medical Associates. His institution received grant support from Physicians’ Services Incorporated Foundation, Hamilton Regional Medical Associates, Hamilton Health Sciences Resident Research Grant in Quality and Patient Safety, and Department of Anesthesia, McMaster University. Dr. Duan received support for travel from Physicians’ Services Incorporated Foundation and Hamilton Regional Medical Associates. His institution received grant support from Physicians' Services Incorporated Foundation, Hamilton Regional Medical Associates, Hamilton Health Sciences Resident Research Grant in Quality and Patient Safety, and Department of Anesthesia, McMaster University. Ms. Hoad’s institution received grant support from Physicians’ Services Incorporated Foundation. Ms. Swinton received a consulting fee for conducting the qualitative analysis for this manuscript and consulted for St. Joseph’s Healthcare Foundation. She is employed by McMaster University. Her institution received grant support from Physicians’ Services Incorporated Foundation, Hamilton Regional Medical Associates, Hamilton Health Sciences Resident Research Grant in Quality and Patient Safety, and Department of Anesthesia, McMaster University. Dr. Perri’s institution received grant support from Physicians' Services Incorporated Foundation. Dr. Cook’s institution received grant support from Physicians Services Incorporated (peer-review grant). Dr. Cook is Research Coordinator of the Canadian Institute of Health Research. Ms. Waugh has disclosed that she does not have any potential conflicts of interest.

For information regarding this article, E-mail: john.centofanti@medportal.ca

© 2014 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins