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Use Of A Bundle Checklist Combined With Provider Confirmation Reduced Risk Of Nosocomial Complications And Death In Trauma Patients
Don Reiff*, Thomas Shoultz*, Russell Griffin*, Benjamin Taylor*, Loring W Rue, III
University of Alabama at Birmingham, Birmingham, AL

Objectives
Bundle checklists are increasingly utilized in patient care, but data is inconsistent regarding their efficacy in reducing nosocomial complication rates. We examined whether checklist usage was associated with nosocomial complications when documented elements were verified by provider bedside rounds.
Methods
We performed a retrospective cohort study of trauma patients admitted to our hospital during a three-phase implementation of a quality improvement project. For this analysis, patients were categorized as pre-documentation (PD), documentation only (DO), or documentation with provider review (PR) cohort based on temporal designations. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between documentation cohorts and nosocomial complications.
Results
No difference in mean hospital stay, ICU days, or ventilator days was observed. The DO cohort showed no significant differences in the risk of complications. Among ICU patients, when compared to the PD cohort, the PR cohort demonstrated a decreased risk of all complications OR 0.72 (95% CI 0.55-0.93), pulmonary embolus OR 0.29 (95% CI 0.11-0.73), pneumonia OR 0.66 (95% CI 0.50-0.88), and death OR 0.50 (95% CI 0.31-0.79).
Conclusion
Bedside confirmation of bundle checklists during physician extender rounds reduces the risk of pulmonary embolus, pneumonia, and death when compared to chart documentation alone. This study underscores the importance of the team approach to the bundle checklist and it’s ability to reduce morbidity and mortality.
Odds ratios* (ORs) and associated 95% confidence intervals (CI) for the association between FASTHUGS
Pre-documentation
cohort (n=1,136)
Documentation only cohort (n=1,160)Documentation and
physician extender check cohort (n=1,185)
OR (95% CI)OR (95% CI)OR (95% CI)
ALL PATIENTS
Any eventRef0.93 (0.72-1.19)0.72 (0.56-0.92)
DVTRef1.01 (0.64-1.59)0.77 (0.48-1.24)
Pulmonary embolismRef0.74 (0.37-1.45)0.31 (0.13-0.73)
PneumoniaRef0.89 (0.67-1.17)0.68 (0.51-0.89)
BacteremiaRef0.94 (0.61-1.44)0.94 (0.61-1.43)
DeathRef0.90 (0.59-1.36)0.50 (0.31-0.79)
* Estimated from logistic regression and adjusted for injury severity score and race


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