The “TRAUMA LIFE” initiative: The impact of a multidisciplinary checklist process on outcomes and communication in a Trauma Intensive Care Unit

• Published in: The American journal of surgery 2018-06, Vol.215 (6), p.1024-1028
• Main Authors: Joseph, Kimberly, Gupta, Sameer, Yon, James, Partida, Renee, Cartagena, Lee, Kubasiak, John, Buie, Vanessa, Miller, Jared, Wiley, Dorion, Nagy, Kimberly, Starr, Frederic, Dennis, Andrew, Kaminsky, Matthew, Bokhari, Faran
• Format: Article
• Language: English
• Subjects: Catheters; Censuses; Check lists; Checklist - methods; Checklists; Collaboration; Communication; Compliance; Critical Care - standards; Data collection; Disease control; Family Message; Follow-Up Studies; Humans; ICU; Intensive care; Intensive Care Units - organization & administration; Medical electronics; Medical records; Patients; Polls & surveys; Pressure ulcers; Quality; Quality Improvement; Quality metrics; Retrospective Studies; Rounding; Surveillance; Sustainability; Thromboembolism; Trauma; Urinary tract diseases; Urinary tract infections; Urogenital system; Ventilators
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2018.03.012

Checklists have been advocated to improve quality outcomes/communication in the critical care setting, but results have been mixed. A new checklist process, “TRAUMA LIFE”, was implemented in our Trauma Intensive Care Unit (TICU) to replace prior checklists. The purpose of this study was to evaluate the impact of the “TRAUMA LIFE” process implementation on quality metrics and on patient/family communication in the TICU. “TRAUMA LIFE” was considered maturely implemented by 2016. Multiple quality metrics, including restraint order compliance, were compared between 2013 and 2016 (pre- and post-implementation). Compliance with the “Family Message” (FM), a part of the “TRAUMA LIFE” communication process, was analyzed in 2016. Improvement was seen in CAUTI, VAE, and IUCU; CLABSI rates increased. Restraint order compliance increased significantly. FM delivery compliance was inconsistent; improvement was noted in concordance between update content and FM documented in Electronic Medical Record. Implementation of “TRAUMA LIFE” was well integrated into the rounding process and was associated with some improvement in quality metrics and communication. Additional evaluation is required to assess sustainability. •A concise, easy to remember checklist (“TRAUMA LIFE”) is used to assist in ICU rounding.•Checklist use was associated with a reduction in key ICU quality metrics including CAUTI, VAE, and restraint compliance.•Concordance between the proposed and delivered daily “Family Message” improved over the study period.