B. K. Yorkgitis1, J. Louglin2, Z. Gandee2, H. H. Bates2, C. Huang2, G. Weinhouse2 1University Of Florida College Of Medicine- Jacksonville,Division Of Acute Care Surgery,Jacksonville, FL, USA 2Brigham And Women’s Hospital,Surgical ICU Transnational Research Center,Boston, MA, USA
Introduction: Surgical ICU patients frequently undergo laboratory and diagnostic testing. These tests can lead to iatrogenic anemia and radiation exposure. Many of these tests and images may be unnecessary for management of a patient’s illness in the SICU and their ordering may be a reflex rather than in response to a clinical question. Checklists have been used in critical care to identify and address various patient care points. Through a quality improvement project, we developed and implement additional points to the daily rounding checklist (DRC) for the bedside SICU care team to address ordering clinically relevant laboratory and chest x-ray (CXR).
Methods: To an already established ICU DRC, two additional points were added: “Is a CXR needed for clinical management tomorrow?” and “What laboratory tests are medical necessary for tomorrow?”. Comparison was made between a three month pre-intervention arm (control group) and three month intervention groups after the addendums were instituted. The groups were compared on a basis of demographics, illness, mean blood test and CXR per day, and average transfusion per day.
Results: A total of 307 adult patients were analyzed, 155 in the control group and 152 in the intervention group. The groups were similar in sex, elective admission status, undergoing surgical procedures, in-hospital death, age, ICU length of stay, ventilator days, and admission SOFA scores (table 1). After the intervention, there was no statistical reduction in laboratory tests or CXR (Table 2).
Conclusion: The addition of these two items to the DRC did not reduce the amount of tests ordered. Checklist fatigue is a well known factor in healthcare and may have contributed to the results. Further education on test appropriateness and the possible addition of a clinician decision tool could be studied in the future to assist with reduction of testing in the SICU that may contribute to ordering only clinically relevant tests.
