ICU checklist reduces deaths by half

The mortality rate dropped 50 percent when physicians in a hospital intensive care unit used a checklist, similar to a pilot's checklist, U.S. researchers say.Lead investigator Dr. Curtis Weiss of Northwestern University Feinberg School of Medicine says since before World War II, U.S. Air Force pilots and co-pilots have used checklists before takeoff, before landing, or during emergencies to keep track of numerous important details, but this is a relatively new concept in medicine. "We showed the checklist itself is just a sheet of paper, but it's how doctors interact with it and best implement it that makes it most effective," Weiss says in a statement. "That's how we came up with prompting."  The checklist is a useful tool only if a physician gets continual reminders -- from his or her "co-pilot" -- to use it to promote decision making, instead of just being a piece of paper that gets shoved in someone's face like busy work, Weiss says. Weiss and colleagues developed a checklist for the intensive care unit that focused on important issues the researchers believed were being overlooked by physicians during daily rounds, such as testing whether a patient can be taken off a ventilator and the duration of empiric antibiotics. The prompting by a physician not actively involved in the patients' care reduced mortality by 50 percent over three months, resulting in part from reducing the time patients were on ventilators and reducing cases of ventilator-associated pneumonia. The finding was published online ahead of print in the American Journal of Respiratory and Critical Care Medicine.