Measurable outcomes of quality improvement using a daily quality rounds checklist: one-year analysis in a trauma intensive care unit with sustained ventilator-associated pneumonia reduction

J Trauma. 2010 Oct;69(4):855-60. doi: 10.1097/TA.0b013e3181c4526f.


Background: We have previously demonstrated that the use of a daily "Quality Rounds Checklist" (QRC) can increase compliance with evidence-based prophylactic measures and decrease complications in a busy trauma intensive care unit (ICU) over a 3-month period. This study was designed to determine the sustainability of QRC use over 1 year and examine the relationship between compliance and outcome improvement.

Methods: A prospective before-after design was used to examine the effectiveness of the QRC tool in documenting compliance with 16 prophylactic measures for ventilator-associated pneumonia (VAP), deep venous thrombosis, pulmonary embolism, catheter-related bloodstream infection, and other ICU complications. The QRC was implemented on a daily basis for a 1-year period by the ICU fellow on duty. Monthly compliance rates were assessed by a multidisciplinary team for development of strategies for real-time improvement. Compliance and outcomes were captured over 1 year of QRC use.

Results: QRC use was associated with a sustained improvement of VAP bundle and other compliance measures over a year of use. After multivariable analysis adjusting for age (> 55), injury mechanism, Glasgow Coma Scale score (≤ 8), and Injury Severity Score (> 20), the rate of VAP was significantly lower after QRC use, with an adjusted mean difference of -6.65 (per 1,000 device days; 95% confidence interval, -9.27 to -4.04; p = 0.008). During the year of QRC use, 3% of patients developed a VAP if all four daily bundle measures were met for the duration of ICU stay versus 14% in those with partial compliance (p = 0.04). The overall VAP rate with full compliance was 5.29 versus 9.23 (per 1,000 device days) with partial compliance. Compared with the previous year, a 24% decrease in the number of pneumonias was recorded for the year of QRC use, representing an estimated cost savings of approximately $400,000.

Conclusion: The use of a QRC facilitates sustainable improvement in compliance rates for clinically significant prophylactic measures in a busy Level I trauma ICU. The daily use of the QRC, requiring just a few minutes per patient to complete, equates to cost-effective improvement in patient outcomes.

MeSH terms

  • Academic Medical Centers
  • Adolescent
  • Adult
  • Aged
  • California
  • Checklist*
  • Cross Infection / mortality
  • Cross Infection / prevention & control
  • Evidence-Based Medicine / standards*
  • Female
  • Guideline Adherence / standards
  • Hospital Mortality
  • Humans
  • Intensive Care Units / standards*
  • Male
  • Middle Aged
  • Pneumonia, Ventilator-Associated / mortality*
  • Pneumonia, Ventilator-Associated / prevention & control*
  • Prospective Studies
  • Quality Assurance, Health Care / standards
  • Quality Indicators, Health Care / standards*
  • Wounds and Injuries / mortality*
  • Wounds and Injuries / therapy
  • Young Adult