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

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

163 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 (US)
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

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Pulmonary and Respiratory Medicine


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