Do Quality Improvement Checklists Decrease ICU Mortality?

HealthDay News – In-hospital mortality was not reduced by implementing directed quality improvement measures, including checklists and clinician prompting, according to a study published in the Journal of the American Medical Association.

Alexandre B. Cavalcanti, MD, PhD, from the HCor-Hospital do Coração in São Paulo, Brazil, and colleagues conducted a two-phase study involving critically ill patients. The first phase was an observational study to examine baseline data on work climate, care processes, and clinical outcomes in 118 Brazilian ICUs.

The second phase was a cluster randomized trial within the same ICUs. A total of 6,877 patients were enrolled in the observational phase and 6,761 in the randomization phase, of whom 3,327 were randomized to a quality improvement intervention involving a daily checklist and goal setting with follow-up clinician prompting, and 3,434 to routine care.

The researchers observed no significant between-group difference in in-hospital mortality (32.9% and 34.8% for intervention and usual care groups, respectively; odds ratio, 1.02; 95% confidence interval, 0.82 to 1.26). Six prespecified secondary outcomes were improved in the intervention group (use of low tidal volumes, avoidance of heavy sedation, use of central venous catheters, use of urinary catheters, perception of team work, and perception of patient safety climate).

Summary and Clinical Applicability

“Among critically ill patients treated in ICUs in Brazil, implementation of a multifaceted quality improvement intervention with daily checklists, goal setting, and clinician prompting did not reduce in-hospital mortality,” the authors write.

It is important to note that although there were no improvements noted in in-hospital mortality, the improvements in certain secondary outcome measures including reduction of ventilator-associated pneumonia may be clinically significant.


Writing Group for the CHECKLIST-ICU Investigators and the Brazilian Research in Intensive Care Network (BRICNet).  Effect of a quality improvement intervention with daily round checklists, goal Setting, and clinician prompting on mortality of critically ill patients. JAMA. 2016;315(14):1480-1490. doi:10.1001/jama.2016.3463.