• Ashley J R De Bie, Eveline Mestrom, Wilma Compagner, Shan Nan, Lenneke van Genugten, Kiran Dellimore, Jacco Eerden, Steffen van Leeuwen, Harald van de Pol, Franklin Schuling, Xudong Lu, Bindels Alexander J G H AJGH Department of Intensive Care Unit, Catharina Hospital Eindhoven, Eindhoven, The Netherlands., Bouwman Arthur R A ARA Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands; Department of Anaesthesiology, Catharina Hosp, and Erik H H M Korsten.
• Department of Internal Medicine, Catharina Hospital Eindhoven, Eindhoven, The Netherlands; Industrial Engineering and Innovation Sciences, Eindhoven University of Technology, Eindhoven, The Netherlands; Department of Intensive Care Unit, Catharina Hospital Eindhoven, Eindhoven, The Netherlands. Electronic address: ashleydebiedekker@gmail.com.
• Br J Anaesth. 2021 Feb 1; 126 (2): 404-414.

BackgroundWe examined whether a context and process-sensitive 'intelligent' checklist increases compliance with best practice compared with a paper checklist during intensive care ward rounds.MethodsWe conducted a single-centre prospective before-and-after mixed-method trial in a 35 bed medical and surgical ICU. Daily ICU ward rounds were observed during two periods of 8 weeks. We compared paper checklists (control) with a dynamic (digital) clinical checklist (DCC, intervention). The primary outcome was compliance with best clinical practice, measured as the percentages of checked items and unchecked critical items. Secondary outcomes included ICU stay and the usability of digital checklists. Data are presented as median (interquartile range).ResultsClinical characteristics and severity of critical illness were similar during both control and intervention periods of study. A total of 36 clinicians visited 197 patients during 352 ward rounds using the paper checklist, compared with 211 patients during 366 ward rounds using the DCC. Per ICU round, a median of 100% of items (94.4-100.0) were completed by DCC, compared with 75.1% (66.7-86.4) by paper checklist (P=0.03). No critical items remained unchecked by the DCC, compared with 15.4% (8.3-27.3) by the paper checklist (P=0.01). The DCC was associated with reduced ICU stay (1 day [1-3]), compared with the paper checklist (2 days [1-4]; P=0.05). Usability of the DCC was judged by clinicians to require further improvement.ConclusionsA digital checklist improved compliance with best clinical practice, compared with a paper checklist, during ward rounds on a mixed ICU.Clinical Trial RegistrationNCT03599856.Copyright © 2020 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.

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