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Improving Reliability to a Care Goal Rounding Template in the Pediatric Intensive Care Unit

BACKGROUND: Effective pediatric intensive care requires addressing many important aspects of care delivery during morning rounds, often achieved using a rounding checklist. Our objective was to develop a care goal rounding template and then double the reliability of discussion of rounding topics dur...

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Autores principales: Efune, Proshad N., Morse, Rustin B., Sheehan, Maeve, Malone, Loren M., Robertson, Tammy S., Darnell, Cindy
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer Health 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6581481/
https://www.ncbi.nlm.nih.gov/pubmed/31334449
http://dx.doi.org/10.1097/pq9.0000000000000117
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author Efune, Proshad N.
Morse, Rustin B.
Sheehan, Maeve
Malone, Loren M.
Robertson, Tammy S.
Darnell, Cindy
author_facet Efune, Proshad N.
Morse, Rustin B.
Sheehan, Maeve
Malone, Loren M.
Robertson, Tammy S.
Darnell, Cindy
author_sort Efune, Proshad N.
collection PubMed
description BACKGROUND: Effective pediatric intensive care requires addressing many important aspects of care delivery during morning rounds, often achieved using a rounding checklist. Our objective was to develop a care goal rounding template and then double the reliability of discussion of rounding topics during morning rounds without the use of a checklist. METHODS: The Institute for Healthcare Improvement Model for Improvement was used for this initiative. A care goal rounding template was established through discussions and consensus with pediatric intensive care unit (PICU) faculty. Rounds were audited in a blinded fashion over a 3-month period to obtain baseline data on rounding topic discussion. Three interventions were then trialed (plan, do, study, act cycles) over a 12-month period. Weekly reliability in rounding topic discussion was tracked. RESULTS: Baseline reliability with discussion of rounding topics was 36%. The first intervention included the use of a standardized progress note in the electronic health record, which contained topics and served to prompt the discussion on rounds. The second intervention was implementation of laminated cards provided to PICU fellows highlighting the elements of the care goal rounding template. The third intervention addressed a standardized handoff sheet often used during rounds. Mean reliability for discussion of rounding topics improved to 52% shortly following the second intervention. Reliability was sustained more than 1 year later. CONCLUSIONS: Following the establishment of a PICU care goal rounding template and various interventions, the reliability in discussing important care goal elements on patient rounds improved.
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spelling pubmed-65814812019-07-22 Improving Reliability to a Care Goal Rounding Template in the Pediatric Intensive Care Unit Efune, Proshad N. Morse, Rustin B. Sheehan, Maeve Malone, Loren M. Robertson, Tammy S. Darnell, Cindy Pediatr Qual Saf Individual QI Projects from Single Institutions BACKGROUND: Effective pediatric intensive care requires addressing many important aspects of care delivery during morning rounds, often achieved using a rounding checklist. Our objective was to develop a care goal rounding template and then double the reliability of discussion of rounding topics during morning rounds without the use of a checklist. METHODS: The Institute for Healthcare Improvement Model for Improvement was used for this initiative. A care goal rounding template was established through discussions and consensus with pediatric intensive care unit (PICU) faculty. Rounds were audited in a blinded fashion over a 3-month period to obtain baseline data on rounding topic discussion. Three interventions were then trialed (plan, do, study, act cycles) over a 12-month period. Weekly reliability in rounding topic discussion was tracked. RESULTS: Baseline reliability with discussion of rounding topics was 36%. The first intervention included the use of a standardized progress note in the electronic health record, which contained topics and served to prompt the discussion on rounds. The second intervention was implementation of laminated cards provided to PICU fellows highlighting the elements of the care goal rounding template. The third intervention addressed a standardized handoff sheet often used during rounds. Mean reliability for discussion of rounding topics improved to 52% shortly following the second intervention. Reliability was sustained more than 1 year later. CONCLUSIONS: Following the establishment of a PICU care goal rounding template and various interventions, the reliability in discussing important care goal elements on patient rounds improved. Wolters Kluwer Health 2018-11-08 /pmc/articles/PMC6581481/ /pubmed/31334449 http://dx.doi.org/10.1097/pq9.0000000000000117 Text en Copyright © 2018 the Author(s). Published by Wolters Kluwer Health, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (http://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
spellingShingle Individual QI Projects from Single Institutions
Efune, Proshad N.
Morse, Rustin B.
Sheehan, Maeve
Malone, Loren M.
Robertson, Tammy S.
Darnell, Cindy
Improving Reliability to a Care Goal Rounding Template in the Pediatric Intensive Care Unit
title Improving Reliability to a Care Goal Rounding Template in the Pediatric Intensive Care Unit
title_full Improving Reliability to a Care Goal Rounding Template in the Pediatric Intensive Care Unit
title_fullStr Improving Reliability to a Care Goal Rounding Template in the Pediatric Intensive Care Unit
title_full_unstemmed Improving Reliability to a Care Goal Rounding Template in the Pediatric Intensive Care Unit
title_short Improving Reliability to a Care Goal Rounding Template in the Pediatric Intensive Care Unit
title_sort improving reliability to a care goal rounding template in the pediatric intensive care unit
topic Individual QI Projects from Single Institutions
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6581481/
https://www.ncbi.nlm.nih.gov/pubmed/31334449
http://dx.doi.org/10.1097/pq9.0000000000000117
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