Supplemental Table 2. Prior studies of Daily Goals Checklists in the intensive care unit
Author, Setting
Design Objective Participants Results
Pronovost et al (2003) (1) 1 surgical oncology ICU, tertiary care hospital, Johns
Hopkins University (Baltimore, MD)
Prospective pre-post survey, clinician interviews Prospective pre-post cohort study
To evaluate the effectiveness of communication during daily ICU rounds and to improve communication through use of a daily goals form (DGF)
112 MDs, 112 RNs,15 HCPs interviewed;
112 patients selected randomly from all patients’
admitted during 8-week study period
Improved understanding of patients’ goals by residents and RNs (10% vs 95%);
Reduced ICU LOS (2.2 vs 1.1 days); RNs reported being an active part of this patient care team; the DGF was an effective
communication tool with families
Hewson et al (2006) (2) 1 ICU, tertiary care hospital, (Penrith, Australia)
Prospective pre-post survey Quantitative analysis of checklist responses
To test the use of a checklist in a tertiary ICU as a method of ensuring processes of care were performed routinely and systematically, as well as a means of collecting data on compliance for quality improvement
10 HCPs surveyed pre- checklist, 15 HCPs surveyed post- checklist;
426 patient assessments, 114 patients
90% of pre-checklist respondents believed it would improve care;
87% of post-checklist respondents reported that checklist was useful and worth continuing; completion in 2.5 minutes (SD 0.72, range = 1.5-4); Benefits:
ensuring important care delivered routinely and systematically, identifying gaps in delivery of care, prompt to pay attention to detail; Barriers: extra paperwork, disruption to rounds on busy days, variations in completion, not structured by organ systems, some terms unclear.
Narasimhan et al (2006) (3)
1 MICU, university affiliated teaching hospital, Beth Israel Medical Centre (New York, NY)
Pre-post survey Prospective pre-post cohort study
To evaluate the effect of a standardized worksheet on MDs’ and RNs’
perceptions of their understanding of goals of care and on patients’
length of stay in an ICU
21 RNs and 17 MDs (attendings, fellows, residents, interns);
All patients admitted to the MICU in two 9 month periods
RNs and MDs reported improved understanding of patients’ goals at 6 wks, sustained at 9 mos;
Improved communication reported at 6 wks by RNs (3.9 vs 4.8 on 5 pt Likert scale; p=0.001) and by MDs (4.6 vs 4.9; p=0.03),
sustained at 9 mos;
Reduced ICU LOS in the study period compared to the same period the previous year (4.3 vs 6.4 days) DuBose et al
(2007) (4) Level 1
Prospective, pre-post intervention study
To assess the effectiveness of implementing a Quality Rounds
All patients admitted during a 1- month pre-
Improved compliance for all measures on the QRC. HOB
>30 (35.2% to 84.5%), sedation holiday (78% to
Trauma ICU (Los
Angeles, CA)
Checklist (QRC) tool to improve compliance with VAP bundles and 12 other prophylactic measures
intervention observation period, followed by a 3-month post- intervention period (Total of 810 patient days)
84.5%), PUD prophylaxis (76.2% to 923%), DVT prophylaxis (91.4% to 92.8%), CVC duration >72h (62.4% to 52.8%), ventilation
>72h (74% to 61.7%), VAP 16.3 vs. 8.9), CVC infection (11.3 vs. 5.8), self-extubation (7.8% vs. 2.2)
Phipps and Thomas (2007) (5) 1 tertiary care, university affiliated PICU (Hershey, PA)
Prospective, longitudinal, pre-post intervention questionnaire
To assess nursing perception of a Daily Goals Sheet (DGS) on communication
All RNs on the PICU invited to participate in both pre- and post-
intervention surveys (26/40 and 22/42 participants, respectively)
85% of nurses reported improved communication between MDs and RNs; 73%
reported improved
communication between RNs on different shifts; 85%
believed improved care was provided to patients
Agarwal et al (2008) (6) 1 PICU, quaternary care, Lucile Packard Children’s Hospital affiliatied with Stanford University (Palo Alto, CA)
Longitudinal pre-post intervention questionnaire study
To determine whether a patient goal sheet (PGS) would improve communication and improve patient care;
primary
outcomes were understanding of patient’s daily goals and LOS
All RNs and resident MDs caring for patients in the pre- and post- intervention periods (419 &
387 total participants, respectively)
Improved understanding of patient care goals (4.2 vs 4.5, p<.001); increased comfort explaining patient care goals to parents (4.1 vs.
4.3, p<.001); more patient care goals identified after PGS implementation (2.6 vs.
2.8, p<.01); LOS unchanged;
76% of respondents reported that the PGS was helpful
Schwartz et al (2008) (7)
1 PICU, tertiary care hospital, Johns Hopkins University (Baltimore, MD)
Qualitative observational study Prospective pre-post cohort study
To describe implementation, uptake and barriers in using a daily goal communication sheet (DGCS)
All patients during 7 days before and after re- education intervention
DGCS facilitated
multidisciplinary input and increased awareness of patients’ daily goals; goal terminology was integrated into team vocabulary; DGCS provided an excellent summary of daily plans, and was useful for complex patients with multiple caregivers; Improved compliance with DGCS usage (8% vs 66%) and fewer defects in PUD prophylaxis (10% vs 3%) Siegele
et al (2009) (8)
1 SICU, community hospital,
Before-after survey Retrospective cohort study
To describe the benefits of implementing a Daily Goal Tool (DGT) and Daily Goals
Reference Tool
RNs completed questionnaire (46%
response rate); all patients
RNs reported improved communication between RNs and MDs (59%), benefit to patient care (72%), enhanced RN
communication (63%) and improved patient safety
open model, Advocate Lutheran General Hospital (Park Ridge, IL)
(DGRT) admitted to the SICU were included
(68%); Improved
implementation of evidenced based guidelines; fostered communication with families, especially end of life care
Weiss et al (2011) (9) 1 MICU, tertiary care hospital, Northwestern Memorial Hospital (Chicago, IL)
Prospective cohort study
To determine whether prompting to use a Daily Rounding Checklist (DRC) addressing 6 parameters during rounds improved patient outcomes
Intervention group: 140 patients;
control group:
125 patients;
number of RNs and MDs NR
Lower risk adjusted hospital mortality (10.0 vs. 20.8%;
p=0.014, OR 0.34 [0.15–
0.76], p=0.008); lower ICU mortality (OR 0.36 [0.13–
0.96], p=0.041); increased ventilator free days (22 vs 16); decreased empiric antibiotics (2 vs 3 days) and CVC duration (3 vs 5 days);
increased rates of DVT prophylaxis (0.96 vs 0.76) and ulcer prophylaxis (0.93 vs 0.83)
Newkirk et al (2012) (10)
Surgical- trauma ICU
& Burn ICU, San Antonio Military Medical Center (Fort Sam
Houston, TX)
Pre-post multi- phase
intervention quantitative study
To study how checklists influence communication patterns among multidisciplinary team members during ICU rounds
Phase 1: 534 STICU rounds
& 66 BICU rounds observed Phase 2: 416 STICU rounds
& 345 BICU rounds observed
Improved discussion of checklist items post
implementation period on the surgical-trauma ICU (36% v 77%, p<0.0001) and on the burn ICU (47% v 72%, p<0.001)
