Compliance in completing checklists in multidisciplinary rounds of intensive careAbstract
Objective Assess compliance in completing a checklist for the multidisciplinary rounds of an intensive care unit (ICU).
Methods This mixed-method study, with a quantitative approach (in the first stage) and a qualitative approach (in the second stage), was performed in an adult ICU of a medium-sized hospital in the Southern region of Brazil. The ‘Suspicion for good’ and ‘Multidisciplinary for ICU rounds’ checklists were used in the quantitative collection of data, and a semi-structured questionnaire was used in the qualitative collection. The quantitative data were analyzed using Fisher’s Exact Test, and the qualitative data were analyzed according to content analysis. Integrated analysis was performed using the combination explained above.
Results General compliance in completing the checklists was determined in the 1st(94.5%) and 2nd(99.6%) periods investigated. Two categories emerged: checklist in multidisciplinary round (adherence vs. barrier) and compliance with the completion of the items listed in the checklist. Adherence to the checklist and high compliance in completing it showed that this instrument contributes to promoting the safety of critical patients.
Conclusion The effective completion of checklists in multidisciplinary rounds is an important safe care management tool in intensive care scenarios.
Keywords:
Checklist; Intensive care units; Teaching rounds; Patient safety; Patient care team
Resumo
Objetivo Avaliar a conformidade no preenchimento de checklist para os rounds multidisciplinares de uma unidade de terapia intensiva (UTI).
Métodos Estudo de método misto, com abordagem quantitativa na primeira etapa e qualitativa na segunda etapa, realizado em uma UTI adulto de um hospital de médio porte na região sul do Brasil. Foram usados os checklists ‘Suspeita para o bem’ e ‘Multidisciplinar para Rounds em UTI’ na coleta de dados quantitativa e um questionário semiestruturado na coleta qualitativa. Os dados quantitativos foram analisados usando o Teste Exato de Fisher e os qualitativos, segundo análise de conteúdo. Foi realizada análise integrada usando a combinação explicada.
Resultados A conformidade geral no preenchimento dos checklists foi determinada nos 1o (94,5%) e 2o (99,6%) períodos investigados. Emergiram duas categorias: Checklist em round multidisciplinar (adesão vs. barreira) e Conformidade com o preenchimento dos itens elencados no checklist. A adesão ao checklist e a alta conformidade com seu preenchimento mostraram que este instrumento contribui para promover a segurança de pacientes críticos.
Conclusão O preenchimento eficaz de checklist em rounds multidisciplinares é uma ferramenta de gestão de cuidado seguro importante nos cenários de assistência intensiva.
Descritores:
Lista de checagem; Unidades de terapia intensiva; Visitas com preceptor; Segurança do paciente; Equipe de assistência ao paciente
Resumen
Objetivo Evaluar el cumplimiento en el llenado de la lista de verificación para las rondas multidisciplinarias de una unidad de terapia intensiva (UTI).
Métodos Estudio de método mixto, con enfoque cuantitativo en la primera etapa y cualitativo en la segunda etapa, realizado en una UTI para adultos de un hospital de mediano tamaño en la región sur de Brasil. Se utilizaron las listas de verificación ‘Sospecha para el bien’ y ‘Multidisciplinar para rondas en la UCI’ en la recopilación de datos cuantitativos y un cuestionario semiestructurado en la recopilación cualitativa. Los datos cuantitativos se analizaron utilizando la prueba exacta de Fisher y los cualitativos, según el análisis de contenido. Se realizó un análisis integrado utilizando la combinación explicada.
Resultados Se determinó el cumplimiento general en el llenado de las listas de verificación en el primer (94,5 %) y segundo (99,6 %) período investigado. Surgieron dos categorías: Lista de verificación en rondas multidisciplinarias (adherencia frente a barrera) y Cumplimiento con el llenado de los ítems enumerados en la lista de verificación. La adhesión a la lista de verificación y el alto cumplimiento en su cumplimentación demostraron que este instrumento contribuye a promover la seguridad de los pacientes críticos.
Conclusión La cumplimentación eficaz de la lista de verificación en rondas multidisciplinares es una herramienta importante para la gestión de la seguridad asistencial en entornos de cuidados intensivos.
Descriptores:
Lista de verificación; Unidades de cuidados intensivos; Rondas de enseñanza; Seguridad del paciente; Grupo de atención al paciente
Introduction
In Intensive Care Units (ICUs), the clinical vulnerability of patients, the different invasive therapeutic possibilities, and possible care failures can interfere with clinical results. Thus, the use of assertive methods in ICU care is essential to reduce possible adverse events and avoidable harm that compromise the safety and evolution of critically ill patients.( 1 )
Among several assertive methods for care practices in high-complexity scenarios, the use of a checklist during multidisciplinary rounds is a strategy that ensures the best care for critical patients and increases the work satisfaction of the multidisciplinary team.( 2 )The literature also confirms that compliance in completing the checklist in the ICU favors greater safety in the care provided by the work team.( 1 )
The use of a checklist during rounds systematizes the care provided by the multidisciplinary team to implement the ideal therapeutic plan for each patient. In addition, standardization and double-checking of the checklist provide assurance to staff and patients. This multidisciplinary work strategy structures the care guidelines listed in the instrument, improves communication between health professionals, and allows for the verification of the goals established for the treatment of critical patients and the evolution of their clinical condition.( 1 )
In multidisciplinary rounds, the use of a checklist helps with evidence-based practices. Thus, it reduces the length of hospital stay, mortality rates in hospitals and ICUs, also reducing adverse events (AE), the use of invasive devices, and healthcare-associated infections (HAIs).( 2 )Thus, the lower rates of catheter-associated urinary tract infection (UTI) and bloodstream infection (BSI), as well as ventilator-associated pneumonia (VAP), are linked to the involvement of all professionals responsible for intensive care, effective communication within the healthcare team, and the daily and systematic completion of the checklist during rounds.( 3 )
A study was conducted in Pakistan to assess compliance with the World Health Organization (WHO) Surgical Safety checklist and explore the barriers faced in its implementation in a hospital complex. After an educational intervention, it identified an improvement of up to 66.7% compliance on the checklist items and found that lack of staff awareness and training were the main barriers to adherence to the instrument.( 4 )Similar to the surgical scenario, the educational strategy for adherence and implementation of technological tools in the context of intensive care increases accuracy and reliability in the safe care process because it is based on legal standards and confirmed scientific evidence.( 5 )
In high complexity environments, such as an ICU, high bed occupancy rates and work overload for nurses and healthcare staff are common. Sometimes, these factors result in barriers to properly completing the checklist during rounds. From the perspective of health professionals, checklists are useless and irrelevant in the face of various activities and intensive care for critically ill patients.( 6 )Therefore, studies with robust methods are necessary to elucidate the adherence of health professionals to the checklist and its effective completion during multidisciplinary rounds.
With basis on the above premises, the question of this study was to know whether the completion of the checklist items, which was performed by health professionals during the multidisciplinary rounds of an ICU, has high compliance. To answer this question, the objective of the study was to evaluate compliance in completing checklists for use in the multidisciplinary rounds of an ICU.
Methods
This mixed-method study was designed using a sequential explanatory approach (according to Creswell’s methodological framework) and conducted by a quantitative step (QUANT; with a higher weight; step 1) connected to a qualitative step (QUAL; with a lower weight; step 2).( 7 )The research was performed based on the results of a doctoral thesis (entitled “Daily multidisciplinary visit associated with the use of checklist in an intensive care unit: a mixed-method study”). It was performed in an adult ICU of a medium-sized philanthropic hospital located in the southern region of Brazil.( 8 )The aforementioned sector has ten beds and is considered a clinical and surgical care center for both the city and region.
In stage 1, two investigation periods were assessed: 1stperiod (round with non-systematic use of checklist 1; ‘Suspicion for Good’ checklist; Feb-Mar 2019) and 2ndperiod (round with systematic use of checklist 2; ‘Multidisciplinary checklist’ for ICU rounds; Feb-Mar 2021). The expressions non-systematic and systematic correspond to completing the checklist on interspersed days and daily, respectively.
In April 2018, daily rounds were implemented in the ICU under study with a multidisciplinary team composed of seven professionals: intensive care (1) and infectious disease (1) specialist doctors; ICU (1) and Permanent Committee on Ethics in Research Involving Human Subjects (CCIH; 2) nurses; physiotherapist (1) and nutritionist (1). In February 2019, checklist 1 was instituted during rounds, but it was completed on interspersed days. In February 2021, checklist 1 was replaced by checklist 2, having been validated by one of the researchers of the present study.( 9 )From this date onwards, it was completed daily by the ICU nurse and/or medical intensivist.
Checklists 1 (16 items) and 2 (12 items) were constituted by intervention and/or care, being based on the best health practices. Of these interventions, 11 care practices were evaluated in this study and were common to both checklists: elevation of the head of the bed (30°); adequate analgesia; mild sedation measured by the Richmond Agitation-Sedation Scale (RASS) with scores from -3 to 0; venous thromboembolism (VTE) prophylaxis; gastric ulcer prophylaxis; adequate nutrition; days of mechanical ventilation (MV), central venous catheter (CVC), and indwelling urinary catheter (IUC) use; blood glucose control; and discontinuation and/or adjustment of antimicrobial doses.( 9 )
For both investigation periods, all checklists present in the medical records of patients admitted to the ICU (aged ≥16 years and hospitalized for ≥48 h) were eligible. Medical records of patients with a confirmed medical diagnosis of brain death were excluded.
In stage 1, data collection was carried out in the period October-December 2022. For data collection, the search was carried out in a database (Microsoft Excel® program) with information on the checklists (versions 1 and 2) used in the ICU under study.( 8 )
Data on checklists 1 and 2 were selected and analyzed in the R ( v . 4.0.2) computational package. Data description was carried out in tables, presenting absolute values, percentages, mean values, and standard deviations. The numerical and non-numerical characteristics of the sample of groups on good care practices were presented by comparing the different investigation periods. The Fisher’s Exact Test was applied considering a significance level of 5% (α=0.05).
Stage 2 (mixed study) was carried out in the period Jan-Mar 2023 after a preliminary analysis of the preponderant/dominant/main data in the Quantitative Stage (QUANT). At this stage, the testimonies of seven health professionals from the ICU under study, who participated in the multidisciplinary rounds, were analyzed. The statements were stored in a (Google Docs®) file under the control of the researcher responsible for the study.
Being an effective member of the ICU’s multidisciplinary rounds was the eligibility criterion to participate in stage 2. The absence of the professional during the data collection period was considered an exclusion criterion. The seven eligible professionals participated in the study without any exclusion, loss, or refusal.
In stage 2, the health professionals participated in the interview, in which a semi-structured questionnaire was used. It was prepared by the researcher, being constituted/formed by both questions about sociodemographic data of health professionals and a guiding question: “Tell me about your multidisciplinary visit and checklist in your clinical practice”.
The interviews were scheduled according to the availability of each professional, recorded in audio, and carried out individually at the institution itself in a private environment (mean duration: 35 min). The objectives of the study and the ethical aspects involving research with human subjects were presented to the participants. During the interview, a field diary was used to record the researcher’s observations.
From the corpus acquired with the narratives fully transcribed in the database, the content analysis technique (thematic modality) was applied following the steps of pre-analysis, exploration of the material, treatment of the results obtained, and interpretation.
The integrated analysis of quantitative and qualitative data was achieved/carried out by connection. In this aspect, the convergences and/or similarities, complementarities, and possible divergences between qualitative data explained and deepened the understanding of quantitative data. To reinforce the mixed character of this study, the Pillar Integration Process (PIP) was constructed. It is a joint display matrix, which uses an integrated conceptual schema, illustrating the quantitative and qualitative results and inserting authorial inferences about the joint density of the data.( 10 )
All ethical and legal precepts regarding research with human beings were met, and the study was registered with the Permanent Committee on Ethics in Research Involving Human Beings (Certificate of Presentation for Ethical Assessment: 32696720.0.0000.0104; COPEP; Universidade Estadual de Maringá, UEM; Opinion: 4,660,168).
Results
A total of 337 checklists were analyzed in checklists 1 (‘Suspicion for Good’; 1stperiod; intervention items: 1,520; 100%) and 2 (‘Multidisciplinary’; 2ndperiod; intervention items: 3,388; 100%). A high general compliance was observed in completing the checklist items in the 1st(94.5%) and 2nd(99.6%) periods investigated ( Table 1 ). The first 12 items of interventions and/or guidelines present in checklists 1 and 2 are common to both periods. In them, glycemic control, VTE prophylaxis, CVC removal, protective MV, antimicrobial medicine, and adequate nutrition showed a significant increase in the percentage of compliance for completing checklist 2 ( p <0.05). The items protective MV (77.9%; checklist 1) and spontaneous breathing test (SBT; 96.7%; checklist 2) were those with the lowest occurrence of compliance in completion. The percentage of overall compliance increased significantly in checklist 2 ( p =0.0001) ( Table 1 ). In both periods investigated, both adherence to the use of the checklist during ICU rounds and compliance in completing the checklists were high. However, overall compliance was significantly higher (99.6%; p =0.0001) during rounds with daily completion of the checklist.
In stage 2 (QUAL), all members of the ICU multidisciplinary team (7) who carried out the rounds in the afternoon period participated in the study. The seven professionals were nurses (3), doctors (2), a physiotherapist (1), and a nutritionist (1), with a mean age of 38 years; six professionals had ≥3 years of experience in the ICU with specialist titles; five were women, and five were married. Two categories emerged from the professionals’ statements: Checklist in multidisciplinary round: adherence vs . barrier; and Compliance with the completion of the items listed in the checklist. The excerpts from the first category reinforce that adherence to the checklist was high because, for the participants, the checklist systematizes multidisciplinary care, ensures good care practice, and reduces the risks of harm to patients.
The checklist directs, systematizes, and standardizes the multidisciplinary visit; this reduced round time and made it possible to expand care beyond the curative physician model. (EA6)
Completing the checklist at the bedside is essential for monitoring by the doctor and other professionals, ensuring good medical practice. (EA7)
Using a checklist in the ICU reduces the risk of harm to patients, and this was the main reason for implementing it in our hospital. (EA1)
Despite notable adherence to the checklist during ICU rounds, barriers to its applicability, such as incidents during the shift, the absence of a manager in the sector, and new professionals, were highlighted.
Sometimes, an emergency, a cardiorespiratory arrest, or other incidents can delay or suspend our round. (EA2)
[...] the lack of a coordinating nurse in the ICU makes things very difficult, because it overloads the nurse who must provide assistance and resolve bureaucratic issues. It’s very busy to fill out the checklist and participate in the rounds every day. (EA1)
The main barrier is the adoption of the new professionals involved, as there are those who don’t value it; I don’t know if they are unfamiliar with the tool or its impacts on the ICU environment. (EA4)
Regarding the second category (from the extracts presented), we noted that health professionals recognized that compliance in completing the items on the checklist favors increased attention and review of the different care discussed in the round, e.g. , the management of the antimicrobial medication.
When evaluating the patient with the multidisciplinary team, we read the test results, suggest other tests, and determine which antibiotic can be started or de-escalated/reduced. (EA2)
The statements on categories explain and deepen quantitative results ( Chart 1 ).
Discussion
The round using a checklist contributed/helped to maximizing the effectiveness of communication and the practice of care. However, this may not produce positive results when rounds are carried out sporadically and without the necessary involvement of all professionals responsible for intensive care.( 11 )When multidisciplinary visits were carried out daily, greater adherence to the checklist and greater compliance with completing the pre-established items for checking were observed. Thus, the daily performance of this practice appears to have motivated the constant and appropriate use of this instrument, favoring the joint work of the health team.
Two items showed a lower occurrence of compliance when completing checklists 1 (protective MV) and 2 (SBT). The literature indicates that adequate ventilatory adjustments improve clinical outcomes and reduce mortality, reducing the risk of lung injury caused by MV.( 8 , 12 )Thus, the precision of the parameter established in MV provides for a ventilatory technique known as “protective”. This allows patients to be ventilated as gently as possible, avoiding pulmonary complications, and favoring ideal muscle function to return to spontaneous ventilatory functions, if linked to the management of nutritional support and hemodynamic condition.( 13 )
Faced with discomfort and respiratory failure, physiotherapists are the professionals who identify the best intervention for patients, monitoring them from the indication of MV to the possibility of weaning through SBT.( 13 )EA2’s testimony (which implicitly signaled the importance of knowing the parameters established on the respirator to make assertive decisions) agreed with the literature. This professional also reported that the intensive care physician responsible for conducting the multidisciplinary visits recognized and valued the presence of the physiotherapist and other health professionals during the rounds to provide better care for patients.
High adherence and compliance in completing checklists 1 and 2’ (Integration Pillar Theme) and the emerging category Checklist in multidisciplinary rounds: adherence vs . barrier represent the importance of using checklists in multidisciplinary rounds despite the adversities/difficulties in their implementation in the ICU. The testimonies highlighted that the use of checklists directs, systematizes, and standardizes multidisciplinary visits, reducing the mean time of rounds in the ICU and ensuring good medical practice.
The above statements agree with a study that examined the impact of a checklist on the quality of patient care transition in the emergency department by resident physicians.( 14 )The study showed that professionals’ adherence to the standardized checklist reduced the mean time of the shift handover and improved the discussion of the items listed in the instrument.
In the present study, the daily completion of checklists was considered fundamental for the surveillance of health professionals, as this expands care beyond the curative medical model. The testimonies revealed that the daily use of checklists improves diet management, thrombosis prophylaxis, and the use of a gastric protector, in addition to other patient safety precautions. More than that, the statements pointed out/indicated that the use of this tool reduces the infection rate, length of hospital stay, mortality, and other avoidable harm to patients.
The above-mentioned results are analogous to those of Brazilian studies and a study carried out on four continents that investigated the use of checklists in multidisciplinary rounds in ICUs.( 2 , 3 , 15 )The studies significantly improved the practice of safe care and reduced avoidable harm (such as adverse events, length of stay, and days of use of invasive devices) to critically ill patients.( 2 , 3 , 12 )In addition, researchers stated that checklists are useful tools for safe care, as their use in high-complexity services encourages professionals to adopt evidence-based practices.( 2 , 3 )This practice is based on preventive care, aiming to repress/replace the reductionist perspective of curative care, resulting in better patient care.( 3 )
The present study also highlighted some barriers to adherence to the checklist (such as the occurrence of emergencies, cardiorespiratory arrest, and other complications) that may delay or suspend the multidisciplinary rounds. Furthermore, the lack of a coordinating nurse in the ICU is pointed out/highlighted as a difficulty due to the overload of supervisory and/or care nurses who need to provide care and deal with bureaucratic problems. The resistance or lack of knowledge of new professionals regarding the importance of checklists and the need to adapt the schedules of various professionals were other barriers mentioned.
In the ICU, where the pace of work is often intense and unpredictable, implementing checklists can be seen as an additional task that consumes time. Healthcare professionals may feel they do not have enough time to adequately complete the checklist during multidisciplinary rounds.( 16 , 17 )
Resistance from healthcare professionals (including doctors, nurses, and other team members) can be a major barrier. Some of them may oppose the implementation of the checklist because they consider it an interference with their usual practices or an unnecessary addition to existing routines. A lack of familiarity with the benefits of this instrument and awareness of its effectiveness may impede its adoption.( 18 )Healthcare professionals may be unaware of studies that show improvements in patient safety and quality of care with the use of checklists . ( 17 )
It is important to highlight that the above-mentioned barriers are not necessarily insurmountable. The literature points to the need to overcome existing challenges in the institutional environment to ensure compliance and adherence to the checklist in multidisciplinary rounds. Strategies for organizational change, continuing and ongoing education, team member engagement, and active leadership can help overcome these barriers and facilitate the successful implementation of the ICU checklist.( 19 )
To reduce the obstacles and barriers mentioned by study participants to adherence to the checklist in rounds, specific strategies (such as raising awareness among new members of the multidisciplinary team, proposing alternative schedules in emergencies, and hiring more professionals to meet management and assistance demands) are necessary.
The significant increase in compliance with completing checklist items in period 2 (Integration Pillar Theme) and the category entitled Compliance with completing checklist items indicates that adherence to the two checklists used in the ICU under study was high. However, when the checklist was completed daily (rather than every other day), a significant increase occurred in completion compliance with the following six items on the instrument: blood glucose control, VTE prophylaxis, CVC removal, protective MV, antibiotic medications, and adequate nutrition.
The testimonies indicate that the checklist guidelines discussed in the round strengthen professional conduct. By completing the instrument items, the team assesses and monitors safe care practices. Therefore, the participation of all members of the multidisciplinary team is essential, especially nurses who provide uninterrupted care for decision-making and clinical improvement of patients.
From the perspective of compliance in completing the checklist during the multidisciplinary round, the literature states that the effective use of this instrument is a care strategy that favors the practice of safe care and better therapeutic results for critical patients.( 2 , 20 )Furthermore, this can be considered a vital practice for comprehensive care, with benefits for the hospital institution, as it enables faster recovery of patients, with shorter hospitalization time and chances of returning due to future complications.( 3 , 20 )
This study had limitations, such as data obtained in a single ICU and failure to observe the time of the professional and/or team to complete the checklist during the multidisciplinary rounds. Furthermore, the Hawthorne effect may have altered the outcomes of the variables, as the knowledge of the study by the multidisciplinary team may have influenced the quality of their efforts in adequately completing the instrument, especially in the last investigation period. To control for the possible Hawthorne effect, the responsible researcher observed the instruments only after they had been applied in the multidisciplinary rounds.
Recognizing that the study has limitations and the data represent a local reality, we suggest conducting other mixed studies to confirm the positive effects of effectively completing the checklists in intensive care and other clinical practice scenarios.
Conclusion
Adherence and high compliance were observed in both checklists used in the multidisciplinary rounds. During the use of the daily checklists, compliance in completing the items, blood glucose control, venous thromboembolism prophylaxis, central venous catheter removal, protective mechanical ventilation, antibiotic medications, and adequate nutrition increased significantly. With the integration of data through the mixed method, adherence to the checklist overcame the barriers to implementing the instrument. Furthermore, high compliance in completing the checklist contributes to maintaining and monitoring safe practices in the ICU.
Data availability
: The authors did not make the data from this article available in repositories prior to submission.
Acknowledgments
Support from the National Council for Scientific and Technological Development (CNPq).
References
- 1 Berg SM, Bittner EA. Disrupting deficiencies in data delivery and decision-making during daily ICU rounds. Crit Care Med. 2019;47(3):478-9.
- 2 Maran E, Matsuda LM, Magalhães AAM, Marcon SS, Oliveira JLC, Cavalcanti AB, et al. Round multiprofissional com checklist: associação com a melhoria na segurança do paciente em terapia intensiva. Rev Gaúcha Enferm. 2022;43(esp):e20210348.
- 3 Maran E, Matsuda LM, Cavalcanti AB, Magalhães AM, Marcon SS, Haddad MD, et al. Effects of multidisciplinary rounds and checklist in an Intensive Care Unit: a mixed methods study. Rev Bras Enferm. 2022;75(3):e20210934.
- 4 Gul F, Nazir M, Abbas K, Khan AA, Malick DS, Khan H, et al. Surgical safety checklist compliance: the clinical audit. Ann Med Surg (Lond). 2022;81:104397.
- 5 Saraiva CO, Andrade FB, Chiavone FB, Barbosa ML, Medeiros SG, Souza NL, et al. Avaliação da segurança do paciente neonatal: construção e validação de protocolo e checklist. Acta Paul Enferm. 2022;35:eAPE0085345.
- 6 Borges ML, Caruso P, Nassar Júnior AP. Nursing workload associated with the frequency of multidisciplinary rounds: a cross-sectional study. Rev Bras Ter Intensiva. 2021;33(1):82-7.
- 7 Creswell JW, Creswell JD. Projeto de Pesquisa: métodos qualitativo, quantitativo e misto. 5a ed. Porto Alegre: Penso; 2021.
- 8 Maran E. Visita multidisciplinar diária associada ao uso de checklist em unidade de terapia intensiva: estudo de método misto [tese]. Maringá: Universidade Estadual de Maringá; 2021.
- 9 Maran E, Matsuda LM, Marcon SS, Haddad MC, Costa MA, Magalhães AM. Adaptação e validação de checklist multidisciplinar para Rounds em Unidade de Terapia Intensiva. Texto Contexto Enferm. 2022;31:e20210047.
- 10 Johnson RE, Grove AL, Clarke A. Pillar integration process: a joint display technique to integrate data in mixed methods research. J Mixed Methods Res. 2019;13(3):301-20.
- 11 Barbosa VR, Lopes MA, Pacheco GM, Pinto JI, Monteiro YF, Pinto SC, et al. Benefícios do round multidisciplinar na unidade de terapia intensiva. Braz J Health Rev. 2020;3(6):17989-8001.
- 12 Peres CG, Pegado AB, Alencar IS, Soares SM, Borborema GD. Ventilação mecânica protetora no paciente com COVID-19. J Arch Health. 2021;2(4):885-8.
- 13 Bastos-Netto CB, Reboredo MM, Vieira RS, Fonseca LM, Carvalho EV, Holanda MA, et al. Ventilação mecânica protetora em pacientes com fator de risco para SDRA: estudo de coorte prospectiva. J Bras Pneumol. 2021;47(1):e20200360.
- 14 Milano A, Stankewicz H, Stoltzfus J, Salen P. The impact of a standardized checklist on transition of care during emergency department resident physician change of shift. West J Emerg Med. 2019;20(1):29-34.
- 15 Kashyap R, Murthy S, Arteaga GM, Dong Y, Cooper L, Kovacevic T, et al.; SCCM Discovery CERTAINp Collaborative Investigators. Effectiveness of a daily rounding checklist on processes of care and outcomes in diverse pediatric Intensive Care Units across the world. J Trop Pediatr. 2021;67(3):fmaa058.
- 16 Abraham J, Kannampallil TG, Patel VL, Patel B, Almoosa KF. Impact of structured rounding tools on time allocation during multidisciplinary rounds: an observational study. JMIR Hum Factors. 2016;3(2):e29.
- 17 Erikson EJ, Edelman DA, Brewster FM, Marshall SD, Turner MC, Sarode VV, et al. The use of checklists in the intensive care unit: a scoping review. Crit Care. 2023;27(1):468.
- 18 Conroy L, Faught JT, Bowers E, Ecclestone G, Fong de Los Santos LE, Hsu A, et al. Medical physics practice guideline 4.b: Development, implementation, use and maintenance of safety checklists. J Appl Clin Med Phys. 2023;24(3):e13895.
- 19 Ribeiro NS. Round multiprofissional em unidade de terapia intensiva: análise de ocorrência e itens do checklist [Trabalho de Conclusão de Curso]. Florianópolis: Universidade Federal de Santa Catarina; 2019.
- 20 Barcellos AR, Chatkin JM. Impacto da aplicação de uma lista de verificação em round multiprofissional nos tempos de ventilação mecânica e permanência em UTI. J Bras Pneumol. 2020;46(3):e20180261.
Edited by
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Associate editor:
Alexandre Pazetto Balsanelli (https://orcid.org/0000-0003-3757-1061) Escola Paulista de Enfermagem, Universidade Federal de São Paulo, São Paulo, SP, Brazil
