Development and Pilot of a Checklist for Management of Acute Liver Failure in the Intensive Care Unit

PLoS One. 2016 May 13;11(5):e0155500. doi: 10.1371/journal.pone.0155500. eCollection 2016.


Introduction: Acute liver failure (ALF) is an ideal condition for use of a checklist. Our aims were to develop a checklist for the management of ALF in the intensive care unit (ICU) and assess the usability of the checklist among multiple providers.

Methods: The initial checklist was developed from published guidelines and expert opinion. The checklist underwent pilot testing at 11 academic liver transplant centers in the US and Canada. An anonymous, written survey was used to assess the usability and quality of the checklist. Written comments were used to improve the checklist following the pilot testing period.

Results: We received 81 surveys involving the management of 116 patients during the pilot testing period. The overall quality of the checklist was judged to be above average to excellent by 94% of users. On a 5-point Likert scale, the majority of survey respondents agreed or agreed strongly with the following checklist characteristics: the checklist was easy to read (99% agreed/agreed strongly), easy to use (97%), items are categorized logically (98%), time to complete the checklist did not interfere with delivery of appropriate and safe patient care (94%) and was not excessively burdensome (92%), the checklist allowed the user the freedom to use his or her clinical judgment (80%), it is a useful tool in the management of acute liver failure (98%). Web-based and mobile apps were developed for use of the checklist at the point of care.

Conclusion: The checklist for the management of ALF in the ICU was shown in this pilot study to be easy to use, helpful and accepted by a wide variety of practitioners at multiple sites in the US and Canada.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Checklist / standards*
  • Health Care Surveys
  • Humans
  • Intensive Care Units / standards*
  • Liver Failure, Acute / therapy*
  • Pilot Projects

Grant support

This work was supported by the National Institutes of Health/National Institute of Diabetes and Digestive and Kidney Diseases DK U-01-58369: WML (Principal Investigator), OKF, IL, CJK, DAG, KAF, RMS, AB, JH, RTS (Site Principal Investigators). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.