Clinical Effection Of Checklist For Early Recognition And Treatment Of Acute Illness In Department Of Critical Care Medicine

Objects:To evaluate theclinicalperformance of Checklist for Early Recognition and Treatment of Acute Illness on patients in the intensive care unit(ICU)enrolled in our hospital.Methods:Inthis prospective observational study,a cohort of 100 patients were treated and collected by the Department of Critical Care Medicine,The Second People's hospital of Lu'an hospitalfrom January 2018 to July 2018(age > 18 years old,the length of ICU stay > 72 h).By convenience sampling methods,50 patients admitted to the hospital from January to April 2018 were selected as the control group.Standard ward inspection was giving to the control group by three senior-and intermediate-level doctors without being informed of the research plan;at the end of March 2018,these three doctors were trained with the CERTAIN checklist byadvisors certified by the Mayo Medical Center's distance learning training.Therewerethreetimesstandardtwo-hourtraining,focusing on the application of CERTAIN and two case analysis.50 patients enrolled from March to July 2018 received patient rounds using CERTAIN(observation group).The ward inspection time and missing items during the ward inspection were recorded for the three senior-and intermediate-level doctors.The CERTAIN checklist contains 20 items that cover the range of daily critical ward rounds and clinicians need to quantify each item.Length of stay in ICU,central venous catheter indwelling time(CVC indwelling time),catheter indwelling time,mechanical ventilation time,drug use rate,ICU mortality,and incidence of adverse events were observed and compared between the study groups.Log-rank univariate analysis and Cox regression multivariate analysis wasappliedto investigate whether the use of CERTAIN is an independent factor that reduces ICU mortality.Results:Compared to control group,we found significant decrease of length of stay in ICU(d:8.68 ± 4.84 vs 13.64 ± 9.37),catheter indwelling time(d:8.16 ± 5.29 vs 13.32 ± 9.31),mechanical ventilation time(d:3.46 ± 4.14 vs 6.62 ± 9.57),insulin use rate(34.0% vs 56.0%)and ICU mortality(2.0% vs 14.0%)in the observation group assigned patient rounds with CERTAIN(P<0.05).Senior-level doctor havegiventhepatient rounds 50 times before and after CERTAIN application,respectively.Intermediate-level doctor havegiventhepatient rounds 100 times before and after CERTAIN application,respectively.Before CERTAIN application,Senior-level doctor havegiventhepatient rounds 50 times and Skin and wound assessment(22%),Nutritional assessment(18%),Physiotherapy and Rehabilitation Therapy(18%)and Stress Ulcer Prevention Assessment(16%)were the items with the highest missing rate;Intermediate-level doctors havegiventhepatient rounds 100 times,Skin and wound assessment(33%)and Nutritional assessment(24%)were the items with the highest missing rate;More than that,Blood sugar control(19%)and Vascular active drug assessment(18%)were missed often by the Intermediate-level doctors;After CERTAIN application,there were significant decrease of the missing rate of the patient rounds items.Besides,the use of CERTAIN can significantly improve the efficiency of the ward inspection.The ward inspection time was shortened from(8.00±0.45)min to(5.0±0.33)min by using the CERTAIN checklist(t = 9.312,P = 0.0007).Survival analysis suggested that CERTAIN application could reduce ICU mortality(?2 = 3.898;P = 0.048),but the use of CERTAIN was not an independent factor for reducing ICU mortality(OR = 1.001,P = 0.922).Conclusions:CERTAIN application has a significant effect on critically ill patients.It should be further promoted in the Department of Critical Care Medicine of China.