Prompting physicians to address a daily checklist for antibiotics: do we need a co-pilot in the ICU?

purpose of reviewFailed opportunities to reduce morbidity and mortality occur when evidence-based therapies are not fully implemented in clinical practice. We reviewed the recent literature on implementation strategies in the intensive care unit, with particular attention to antibiotic therapy. RECENT

findingsEmphasis in implementation science has shifted to new models that focus more on direct, point-of-care interaction with providers as opposed to an administrative or top-down approach. Prompting physicians to use a multifaceted checklist was associated with a decrease in severity-adjusted mortality and length of stay. The majority of the benefit appears to correlate with decreased use of empirical antibiotics. A subsequent study demonstrated that face-to-face prompting regarding empirical antibiotics alone was still superior to an electronic checklist, but that long-term changes in use of empirical antibiotics resulted from the previous prompting study. Other studies demonstrate that checklists result in enhanced communication between caregivers, which may be a major explanation for their benefit. SUMMARY: Newer implementation strategies focused on real-time, point-of-care interventions have been associated with greater impact. The most common of these new interventions is use of checklists. Greater checklist use has led to the realization that a prompting or forcing function is required for optimal benefit.