Enhancing patient safety in the trauma/surgical intensive care unit

Kenneth Stahl, Albert Palileo, Carl I Schulman, Katherine Wilson, Jeffrey Augenstein, Chauniqua Kiffin, Mark McKenney

Research output: Contribution to journalArticle

40 Citations (Scopus)

Abstract

Background: Preventable deaths due to errors in trauma patients with otherwise survivable injuries account for up to 10% of fatalities in Level I trauma centers, 50% of these errors occur in the intensive care unit (ICU). The root cause of 67% of the Joint Commission sentinel events is communication errors. The objective is (1) to study how critical information degrades and how it is lost over 24 hours and (2) to determine whether a structured checklist for ICU handoffs prevents information loss. Methods: Prospective cohort study of trauma and surgical ICU teams observed with and without use of the checklist. An observational period (control group) was followed by a didactic session on the science and use of a checklist (study group), which was used for patient management and handoffs. Information was tracked for a 24-hour period and all handoffs. Comparisons use χ2 or Fisher's exact test and a p value <0.05 was defined as significant. Results: Three hundred and thirty-two patient ICU days were observed (119 control, 213 study) and 689 patient care items (303 control, 386 study) were followed. Seventy-five (10.9%) items were lost over 24 hours; 61 of 303 (20.1%) without checklist and 14 of 386 (3.6%) with checklist (p < 0.0001). Critical laboratory values and test results were the most frequent lost items (36.1% control vs. 4.5% study p < 0.0001). Six of 75 (8.1%) items were correctly ordered but not carried out by ICU nursing staff-all caught and corrected with checklist use. Conclusion: Critical information is degraded over 24 hours in the ICU. A structured checklist significantly reduces patient errors due to lost information and communication lapses between trauma ICU team members at handoffs of care.

Original languageEnglish
Pages (from-to)430-433
Number of pages4
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume67
Issue number3
DOIs
StatePublished - Sep 1 2009

Fingerprint

Critical Care
Patient Safety
Checklist
Intensive Care Units
Wounds and Injuries
Patient Care
Communication
Critical Care Nursing
Trauma Centers
Nursing Staff
Cohort Studies
Joints
Prospective Studies
Control Groups

Keywords

  • Checklist
  • Communication
  • Critical data
  • Handoff of care
  • Patient safety
  • Prospective

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Enhancing patient safety in the trauma/surgical intensive care unit. / Stahl, Kenneth; Palileo, Albert; Schulman, Carl I; Wilson, Katherine; Augenstein, Jeffrey; Kiffin, Chauniqua; McKenney, Mark.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 67, No. 3, 01.09.2009, p. 430-433.

Research output: Contribution to journalArticle

Stahl, Kenneth ; Palileo, Albert ; Schulman, Carl I ; Wilson, Katherine ; Augenstein, Jeffrey ; Kiffin, Chauniqua ; McKenney, Mark. / Enhancing patient safety in the trauma/surgical intensive care unit. In: Journal of Trauma - Injury, Infection and Critical Care. 2009 ; Vol. 67, No. 3. pp. 430-433.
@article{e34567798f3044ef85f6d3834f1524c3,
title = "Enhancing patient safety in the trauma/surgical intensive care unit",
abstract = "Background: Preventable deaths due to errors in trauma patients with otherwise survivable injuries account for up to 10{\%} of fatalities in Level I trauma centers, 50{\%} of these errors occur in the intensive care unit (ICU). The root cause of 67{\%} of the Joint Commission sentinel events is communication errors. The objective is (1) to study how critical information degrades and how it is lost over 24 hours and (2) to determine whether a structured checklist for ICU handoffs prevents information loss. Methods: Prospective cohort study of trauma and surgical ICU teams observed with and without use of the checklist. An observational period (control group) was followed by a didactic session on the science and use of a checklist (study group), which was used for patient management and handoffs. Information was tracked for a 24-hour period and all handoffs. Comparisons use χ2 or Fisher's exact test and a p value <0.05 was defined as significant. Results: Three hundred and thirty-two patient ICU days were observed (119 control, 213 study) and 689 patient care items (303 control, 386 study) were followed. Seventy-five (10.9{\%}) items were lost over 24 hours; 61 of 303 (20.1{\%}) without checklist and 14 of 386 (3.6{\%}) with checklist (p < 0.0001). Critical laboratory values and test results were the most frequent lost items (36.1{\%} control vs. 4.5{\%} study p < 0.0001). Six of 75 (8.1{\%}) items were correctly ordered but not carried out by ICU nursing staff-all caught and corrected with checklist use. Conclusion: Critical information is degraded over 24 hours in the ICU. A structured checklist significantly reduces patient errors due to lost information and communication lapses between trauma ICU team members at handoffs of care.",
keywords = "Checklist, Communication, Critical data, Handoff of care, Patient safety, Prospective",
author = "Kenneth Stahl and Albert Palileo and Schulman, {Carl I} and Katherine Wilson and Jeffrey Augenstein and Chauniqua Kiffin and Mark McKenney",
year = "2009",
month = "9",
day = "1",
doi = "10.1097/TA.0b013e3181acbe75",
language = "English",
volume = "67",
pages = "430--433",
journal = "Journal of Trauma and Acute Care Surgery",
issn = "2163-0755",
publisher = "Lippincott Williams and Wilkins",
number = "3",

}

TY - JOUR

T1 - Enhancing patient safety in the trauma/surgical intensive care unit

AU - Stahl, Kenneth

AU - Palileo, Albert

AU - Schulman, Carl I

AU - Wilson, Katherine

AU - Augenstein, Jeffrey

AU - Kiffin, Chauniqua

AU - McKenney, Mark

PY - 2009/9/1

Y1 - 2009/9/1

N2 - Background: Preventable deaths due to errors in trauma patients with otherwise survivable injuries account for up to 10% of fatalities in Level I trauma centers, 50% of these errors occur in the intensive care unit (ICU). The root cause of 67% of the Joint Commission sentinel events is communication errors. The objective is (1) to study how critical information degrades and how it is lost over 24 hours and (2) to determine whether a structured checklist for ICU handoffs prevents information loss. Methods: Prospective cohort study of trauma and surgical ICU teams observed with and without use of the checklist. An observational period (control group) was followed by a didactic session on the science and use of a checklist (study group), which was used for patient management and handoffs. Information was tracked for a 24-hour period and all handoffs. Comparisons use χ2 or Fisher's exact test and a p value <0.05 was defined as significant. Results: Three hundred and thirty-two patient ICU days were observed (119 control, 213 study) and 689 patient care items (303 control, 386 study) were followed. Seventy-five (10.9%) items were lost over 24 hours; 61 of 303 (20.1%) without checklist and 14 of 386 (3.6%) with checklist (p < 0.0001). Critical laboratory values and test results were the most frequent lost items (36.1% control vs. 4.5% study p < 0.0001). Six of 75 (8.1%) items were correctly ordered but not carried out by ICU nursing staff-all caught and corrected with checklist use. Conclusion: Critical information is degraded over 24 hours in the ICU. A structured checklist significantly reduces patient errors due to lost information and communication lapses between trauma ICU team members at handoffs of care.

AB - Background: Preventable deaths due to errors in trauma patients with otherwise survivable injuries account for up to 10% of fatalities in Level I trauma centers, 50% of these errors occur in the intensive care unit (ICU). The root cause of 67% of the Joint Commission sentinel events is communication errors. The objective is (1) to study how critical information degrades and how it is lost over 24 hours and (2) to determine whether a structured checklist for ICU handoffs prevents information loss. Methods: Prospective cohort study of trauma and surgical ICU teams observed with and without use of the checklist. An observational period (control group) was followed by a didactic session on the science and use of a checklist (study group), which was used for patient management and handoffs. Information was tracked for a 24-hour period and all handoffs. Comparisons use χ2 or Fisher's exact test and a p value <0.05 was defined as significant. Results: Three hundred and thirty-two patient ICU days were observed (119 control, 213 study) and 689 patient care items (303 control, 386 study) were followed. Seventy-five (10.9%) items were lost over 24 hours; 61 of 303 (20.1%) without checklist and 14 of 386 (3.6%) with checklist (p < 0.0001). Critical laboratory values and test results were the most frequent lost items (36.1% control vs. 4.5% study p < 0.0001). Six of 75 (8.1%) items were correctly ordered but not carried out by ICU nursing staff-all caught and corrected with checklist use. Conclusion: Critical information is degraded over 24 hours in the ICU. A structured checklist significantly reduces patient errors due to lost information and communication lapses between trauma ICU team members at handoffs of care.

KW - Checklist

KW - Communication

KW - Critical data

KW - Handoff of care

KW - Patient safety

KW - Prospective

UR - http://www.scopus.com/inward/record.url?scp=70449122839&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=70449122839&partnerID=8YFLogxK

U2 - 10.1097/TA.0b013e3181acbe75

DO - 10.1097/TA.0b013e3181acbe75

M3 - Article

C2 - 19741381

AN - SCOPUS:70449122839

VL - 67

SP - 430

EP - 433

JO - Journal of Trauma and Acute Care Surgery

JF - Journal of Trauma and Acute Care Surgery

SN - 2163-0755

IS - 3

ER -