Prompting physicians to address a daily checklist for antibiotics: Do we need a co-pilot in the ICU?

Curtis H. Weiss, Richard G. Wunderink*

*Corresponding author for this work

Research output: Contribution to journalReview article

6 Scopus citations

Abstract

PURPOSE OF REVIEW: Failed opportunities to reduce morbidity and mortality occur when evidence-based therapies are not fully implemented in clinical practice. We reviewed the recent literature on implementation strategies in the intensive care unit, with particular attention to antibiotic therapy. RECENT FINDINGS: Emphasis in implementation science has shifted to new models that focus more on direct, point-of-care interaction with providers as opposed to an administrative or top-down approach. Prompting physicians to use a multifaceted checklist was associated with a decrease in severity-Adjusted mortality and length of stay. The majority of the benefit appears to correlate with decreased use of empirical antibiotics. A subsequent study demonstrated that face-to-face prompting regarding empirical antibiotics alone was still superior to an electronic checklist, but that long-term changes in use of empirical antibiotics resulted from the previous prompting study. Other studies demonstrate that checklists result in enhanced communication between caregivers, which may be a major explanation for their benefit. SUMMARY: Newer implementation strategies focused on real-time, point-of-care interventions have been associated with greater impact. The most common of these new interventions is use of checklists. Greater checklist use has led to the realization that a prompting or forcing function is required for optimal benefit.

Original languageEnglish (US)
Pages (from-to)448-452
Number of pages5
JournalCurrent opinion in critical care
Volume19
Issue number5
DOIs
StatePublished - Oct 2013

Keywords

  • Checklist
  • Decision support
  • Implementation
  • Prompting

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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