Development and Pilot of a Checklist for Management of Acute Liver Failure in the Intensive Care Unit
Oren K Fix, Iris Liou, Constantine J Karvellas, Daniel R Ganger, Kimberly A Forde, Ram M Subramanian, Alice Boylan, James Hanje, R Todd Stravitz, William M Lee, Acute Liver Failure Study Group, Oren K Fix, Iris Liou, Constantine J Karvellas, Daniel R Ganger, Kimberly A Forde, Ram M Subramanian, Alice Boylan, James Hanje, R Todd Stravitz, William M Lee, Acute Liver Failure Study Group
Abstract
Introduction: Acute liver failure (ALF) is an ideal condition for use of a checklist. Our aims were to develop a checklist for the management of ALF in the intensive care unit (ICU) and assess the usability of the checklist among multiple providers.
Methods: The initial checklist was developed from published guidelines and expert opinion. The checklist underwent pilot testing at 11 academic liver transplant centers in the US and Canada. An anonymous, written survey was used to assess the usability and quality of the checklist. Written comments were used to improve the checklist following the pilot testing period.
Results: We received 81 surveys involving the management of 116 patients during the pilot testing period. The overall quality of the checklist was judged to be above average to excellent by 94% of users. On a 5-point Likert scale, the majority of survey respondents agreed or agreed strongly with the following checklist characteristics: the checklist was easy to read (99% agreed/agreed strongly), easy to use (97%), items are categorized logically (98%), time to complete the checklist did not interfere with delivery of appropriate and safe patient care (94%) and was not excessively burdensome (92%), the checklist allowed the user the freedom to use his or her clinical judgment (80%), it is a useful tool in the management of acute liver failure (98%). Web-based and mobile apps were developed for use of the checklist at the point of care.
Conclusion: The checklist for the management of ALF in the ICU was shown in this pilot study to be easy to use, helpful and accepted by a wide variety of practitioners at multiple sites in the US and Canada.
Conflict of interest statement
Competing Interests: The authors have declared that no competing interests exist.
Figures
References
- Trey C, Davidson CS. The management of fulminant hepatic failure. Prog Liver Dis 1970;3:282–98.
- Lee WM. Acute liver failure in the United States. Semin Liver Dis 2003;23:217–26.
- Bernal W, Hyyrylainen A, Gera A, Audimoolam VK, McPhail MJ, Auzinger G, et al. Lessons from look-back in acute liver failure? A single centre experience of 3300 patients. J Hepatol 2013;59:74–80. 10.1016/j.jhep.2013.02.010
- Hales B, Terblanche M, Fowler R, Sibbald W. Development of medical checklists for improved quality of patient care. Int J Qual Health Care 2008;20:22–30.
- Winters BD, Gurses AP, Lehmann H, Sexton JB, Rampersad CJ, Pronovost PJ. Clinical review: checklists—translating evidence into practice. Crit Care 2009;13:210.
- Berenholtz SM, Pronovost PJ, Lipsett PA, Hobson D, Earsing K, Farley JE, et al. Eliminating catheter-related bloodstream infections in the intensive care unit. Crit Care Med 2004;32:2014–20.
- Haynes AB, Weiser TG, Berry WR, Lipsitz SR, Breizat AH, Dellinger EP, et al. A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med 2009;360:491–9. 10.1056/NEJMsa0810119
- Stravitz RT, Kramer AH, Davern T, Shaikh AO, Caldwell SH, Mehta RL, et al. Intensive care of patients with acute liver failure: recommendations of the U.S. Acute Liver Failure Study Group. Crit Care Med 2007;35:2498–508.
- Bernal W, Auzinger G, Sizer E, Wendon J. Intensive care management of acute liver failure. Semin Liver Dis 2008;28:188–200. 10.1055/s-2008-1073118
Source: PubMed