Prospective application of the interdisciplinary bedside rounding checklist ‘TEMP’ is associated with reduced infections and length of hospital stay

BMJ Open Quality

article

Nila S Radhakrishnan¹  Kiran Lukose¹  Richard Cartwright²  Andressa Sleiman³  Nicholas Matey³  Duke Lim⁴  Tiffany LeGault⁴  Sapheria Pollard⁴  Nicole Gravina³  Frederick S Southwick¹ 

[1] Department of Medicine , University of Florida College of Medicine;Office of Clinical Quality and Patient Safety , University of Florida Health;Department of Psychology , University of Florida;Department of Nursing , University of Florida Health

关键词: Checklists;    Communication;    Continuous quality improvement;    Healthcare quality improvement;    Implementation science;   

DOI  :  10.1136/bmjoq-2022-002045

学科分类：药学

来源: BMJ Publishing Group

【 摘 要 】

Protocols that enhance communication between nurses, physicians and patients have had a variable impact on the quality and safety of patient care. We combined standardised nursing and physician interdisciplinary bedside rounds with a mnemonic checklist to assure all key nursing care components were modified daily. The mnemonic TEMP allowed the rapid review of 11 elements. T stands for tubes assuring proper management of intravenous lines and foleys; E stands for eating, exercise, excretion and sleep encouraging a review of orders for diet, exercise, laxatives to assure regular bowel movements, and inquiry about sleep; M stands for monitoring reminding the team to review the need for telemetry and the frequency of vital sign monitoring as well as the need for daily blood tests; and P stands for pain and plans reminding the team to discuss pain medications and to review the management plan for the day with the patient and family. Faithful implementation eliminated central line-associated bloodstream infections and catheter-associated urinary tract infections and resulted in a statistically significant reduction in average hospital length of stay of 13.3 hours, one unit achieving a 23-hour reduction. Trends towards reduced 30-day readmissions (20% down to 10%–11%) were observed. One unit improved the percentage of patients who reported nurses and doctors always worked together as a team from a 56% baseline to 75%. However, the combining of both units failed to demonstrate statistically significant improvement. Psychologists well versed in implementing behavioural change were recruiting to improve adherence to our protocols. Following training physicians and nurses achieved adherence levels of over 70%. A high correlation (r2=0.69) between adherence and reductions in length of stay was observed emphasising the importance of rigorous training and monitoring of performance to bring about meaningful and reliable improvements in the efficiency and quality of patient care.ChecklistsCommunicationContinuous quality improvementHealthcare quality improvementImplementation scienceData availability statementData are available on reasonable request. Data were derived from our electronic records and mailed in surveys and can be provided on request.http://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

【 授权许可】

CC BY-NC|CC BY|CC BY-NC-ND