• Marija Vukoja, Yue Dong, AdhikariNeill K JNKJThe Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia.Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia.Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN.Department of, Marcus J Schultz, Yaseen M Arabi, Ignacio Martin-Loeches, Manuel Hache, Srdjan Gavrilovic, Rahul Kashyap, Ognjen Gajic, and Checklist for Early Recognition and Treatment of Acute Illness and Injury (CERTAIN) Investigators of the SCCM Discovery Network.
• The Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia.
• Crit. Care Med. 2021 Jun 1; 49 (6): e598e612e598-e612.

ObjectivesTo determine whether the "Checklist for Early Recognition and Treatment of Acute Illness and Injury" decision support tool during ICU admission and rounding is associated with improvements in nonadherence to evidence-based daily care processes and outcomes in variably resourced ICUs.Design, Settings, PatientsThis before-after study was performed in 34 ICUs (15 countries) from 2013 to 2017. Data were collected for 3 months before and 6 months after Checklist for Early Recognition and Treatment of Acute Illness and Injury implementation.InterventionsChecklist for Early Recognition and Treatment of Acute Illness and Injury implementation using remote simulation training.Measurements And Main ResultsThe coprimary outcomes, modified from the original protocol before data analysis, were nonadherence to 10 basic care processes and ICU and hospital length of stay. There were 1,447 patients in the preimplementation phase and 2,809 patients in the postimplementation phase. After adjusting for center effect, Checklist for Early Recognition and Treatment of Acute Illness and Injury implementation was associated with reduced nonadherence to care processes (adjusted incidence rate ratio [95% CI]): deep vein thrombosis prophylaxis (0.74 [0.68-0.81), peptic ulcer prophylaxis (0.46 [0.38-0.57]), spontaneous breathing trial (0.81 [0.76-0.86]), family conferences (0.86 [0.81-0.92]), and daily assessment for the need of central venous catheters (0.85 [0.81-0.90]), urinary catheters (0.84 [0.80-0.88]), antimicrobials (0.66 [0.62-0.71]), and sedation (0.62 [0.57-0.67]). Analyses adjusted for baseline characteristics showed associations of Checklist for Early Recognition and Treatment of Acute Illness and Injury implementation with decreased ICU length of stay (adjusted ratio of geometric means [95% CI]) 0.86 [0.80-0.92]), hospital length of stay (0.92 [0.85-0.97]), and hospital mortality (adjusted odds ratio [95% CI], 0.81 (0.69-0.95).ConclusionsA quality-improvement intervention with remote simulation training to implement a decision support tool was associated with decreased nonadherence to daily care processes, shorter length of stay, and decreased mortality.Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine and Wolters Kluwer Health, Inc.

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