Background
Methods
Protocol registration
Search strategy
Inclusion and exclusion criteria
Quality assessment and synthesis
Description of the study |
1. Patient/population |
2. Number |
3. Setting |
4. Intervention |
5. Comparison/control |
6. Outcomes |
7. Inclusion criteria |
8. Exclusion criteria |
Study validity |
1. Were there any conflicts of interest in the writing or funding of this study? |
2. Does the study have a clearly focused question? |
3. Is a cohort study the appropriate method to answer this question? |
4. Does the study have specified inclusion/exclusion criteria? |
5. If there were specified inclusion/exclusion criteria, were these appropriate? |
6. Other than the exposure under investigation, were the groups selected from similar populations? |
7. Aside from the exposure, were the groups treated the same? |
8. Was exposure measured in a standard, valid and reliable way? |
9. Were outcome assessors blind to the exposure? |
10. Were all outcomes measured in a standard, valid and reliable way? |
11. Were outcomes assessed objectively and independently? |
12. Is the paper free of selective outcome reporting? |
13. Were the outcomes measured appropriate? |
14. Was there sufficient duration of follow up? |
15. Was the study sufficiently powered to detect any differences between the groups? |
16. If statistical analysis was undertaken, was this appropriate? |
17. Were the groups similar at baseline with regards to key prognostic variables? |
18. What percentage of the individuals recruited into each arm of the study were lost to follow up? |
19. What percentages of the individuals were not included in the analysis? |
Other 1. What is the overall risk of bias? |
Results |
Authors' conclusions |
Our comments |
Setting | Study | Quality assessment* | ||||||
---|---|---|---|---|---|---|---|---|
No conflict of interest | Appropriate study design | Appropriate participant selection | Appropriate allocation concealment and blinding | Appropriate data collection methods used | Outcome attributable to intervention | Appropriate analysis | ||
ICU | Agarwal et al 2008 [3] | ? | + | + | ? | + | + | + |
Berenholtz et al 2004 [4] | ++ | + | ? | - | + | + | + | |
Byrnes et al 2009 [5] | ++ | + | ? | ? | + | ++ | ? | |
Narasimhan et al 2006 [6] | ? | + | ? | ? | + | + | ? | |
Pronovost et al 2003 [7] | ? | + | ? | ? | + | + | ? | |
ED | Gokula et al 2007 [8] | ? | + | + | ? | + | + | + |
Romagnuolo et al 2005 [9] | ? | + | ++ | ? | + | + | ++ | |
Surgery | Haynes et al 2009 [10] | ++ | + | + | - | + | + | + |
Acute care | Weingarten Jr et al 2004 [11] | ? | + | + | ? | + | ? | ? |
Missing data
Results
Search results
Setting | Study | Population | Intervention | Control | Outcomes |
---|---|---|---|---|---|
ICU | Agarwal et al 2008 [3] | 641 paediatric ICU (PICU) patients | Daily patient goal sheet plus education aimed at PICU nurses, paediatric residents, paediatric critical care fellows, and PICU attending physicians | Standard care | Length of stay (LOS) (days) |
Berenholtz et al 2004 [4] | 68 surgical ICU (SICU) patients requiring mechanical ventilation | Safety checklist and education aimed at surgeons, and an intensivist-led multidisciplinary team that includes ICU attending physicians and fellows, anesthesia and surgery residents, nurse practitioners, nurses, and a pharmacist | Standard care | Percentage of ventilator days per week when patients received all four care processes of semi-recumbent positioning (for prevention of ventilator-associated pneumonia (VAP)), appropriate sedation, appropriate peptic ulcer disease (PUD) prophylaxis, and appropriate deep venous thrombosis (DVT) prophylaxis | |
Byrnes et al 2009 [5] | 1285 surgical/burn/trauma ICU patients | Checklist of ICU protocols and objectives requiring verbal review, plus education, aimed at all attending staff and fellows | Standard care | Time from admission until prescription of medical DVT prophylaxis (days), utilisation of physical therapy (%), transferral to telemetry (%), and central catheter duration (days) | |
Narasimhan et al 2006 [6] | ICU patients. Number of patients is not reported. | Daily goals worksheet that allows staff to fill in information on various patient care processes | Standard care | LOS | |
Pronovost et al 2003 [7] | ICU patients. Number of patients is not reported. | Daily goals form that asks staff to state the tasks to be completed, care plan, and communication plan | Standard care | LOS | |
ED | Gokula et al 2007 [8] | 200 patients of any age admitted to the ED and had an indwelling urinary tract catheter (IUTC) placed in the ED prior to admission to the hospital | Safety checklist used during care, plus education on using the safety checklists aimed at physicians and nurses | Standard care | Presence of an appropriate indication for use of an IUTC, documentation of an indication for IUTC, and a physician order for the IUTC |
Romagnuolo et al 2005 [9] | 61 patients whose primary diagnosis was upper gastrointestinal bleeding | Post-endoscopy checklist to be filled out by the endoscopist after ED admission | Standard care | Patient LOS and readmission rates | |
Surgery | Haynes et al 2009 [10] | 7688 patients ≥ 16 years old and who were undergoing non-cardiac surgery. Eight hospitals from eight countries. | 19-item surgical safety checklist, which was delivered with educational training, aimed at surgical teams | Standard care | The primary outcome was occurrence of any major complication including death, during the period of postoperative hospitalization, up to 30 days. The secondary outcomes were six safety process measures |
Acute care | Weingarten Jr et al 2004 [11] | 12 acute-care hospitals across 15 states in the USA. Number of patients unknown. | Medical record checklists, forms and reminders, which were filled out by physicians or nursing staff. Hospitals chose the intervention strategy that suited their institution, so it is likely they were different across hospitals. | Standard care without any checklists, forms or reminders | Proportion of patients receiving antibiotics within eight hours of a diagnosis of pneumonia |
Study quality
Study findings
Setting | Number of studies | Results | Comments |
---|---|---|---|
ICU | 5 | Different checklists were used, and different outcomes were measured. There was reduction of patient LOS for some studies, and improvements in compliance in some care processes in some studies, but these were not consistent across all studies | |
ED | 2 | Different checklists were used, and different outcomes were measured. Appropriate use of catheters increased following the intervention but was not statistically significant. There was a statistically significant decrease in LOS using the checklist. | |
Surgery | 1 | The rate of any complication, surgical-site infection, unplanned reoperation, and death fell significantly with checklist use. The incidence of pneumonia did not improve. | The one study [10] had a moderate risk of bias |
Acute care | 1 | Checklists significantly improved antibiotic administration within eight hours for patients with pneumonia, with patients approximately two times as likely to receive antibiotics within eight hours compared to patients without checklists. | The one study [11] had a high risk of bias |