Intelligent checklists improve checklist compliance in the intensive care unit: a prospective before-and-after mixed-method study

Ashley J.R. de Bie (Corresponding author), Eveline Mestrom, Wilma Compagner, Shan Nan, Lenneke van Genugten, Kiran Dellimore, Jacco Eerden, Steffen van Leeuwen, Harald van de Pol, Franklin Schuling, Xudong Lu, Alexander J.G.H. Bindels, Arthur R.A. Bouwman, Erik H.H.M. Korsten

Research output: Contribution to journalArticleAcademicpeer-review

6 Citations (Scopus)


Background: We examined whether a context and process-sensitive ‘intelligent’ checklist increases compliance with best practice compared with a paper checklist during intensive care ward rounds. Methods: We conducted a single-centre prospective before-and-after mixed-method trial in a 35 bed medical and surgical ICU. Daily ICU ward rounds were observed during two periods of 8 weeks. We compared paper checklists (control) with a dynamic (digital) clinical checklist (DCC, intervention). The primary outcome was compliance with best clinical practice, measured as the percentages of checked items and unchecked critical items. Secondary outcomes included ICU stay and the usability of digital checklists. Data are presented as median (interquartile range). Results: Clinical characteristics and severity of critical illness were similar during both control and intervention periods of study. A total of 36 clinicians visited 197 patients during 352 ward rounds using the paper checklist, compared with 211 patients during 366 ward rounds using the DCC. Per ICU round, a median of 100% of items (94.4–100.0) were completed by DCC, compared with 75.1% (66.7–86.4) by paper checklist (P=0.03). No critical items remained unchecked by the DCC, compared with 15.4% (8.3–27.3) by the paper checklist (P=0.01). The DCC was associated with reduced ICU stay (1 day [1–3]), compared with the paper checklist (2 days [1–4]; P=0.05). Usability of the DCC was judged by clinicians to require further improvement. Conclusions: A digital checklist improved compliance with best clinical practice, compared with a paper checklist, during ward rounds on a mixed ICU. Clinical trial registration: NCT 03599856.

Original languageEnglish
Pages (from-to)404-414
Number of pages11
JournalBritish Journal of Anaesthesia
Issue number2
Publication statusPublished - Feb 2021


  • checklist
  • clinical decision support system
  • intensive care unit
  • medical errors
  • patient safety
  • technology acceptance
  • Prospective Studies
  • Humans
  • Practice Patterns, Physicians'/standards
  • Decision Support Systems, Clinical
  • Quality Indicators, Health Care/standards
  • Benchmarking/standards
  • Attitude to Computers
  • Patient Safety
  • Critical Care/standards
  • Length of Stay
  • Quality Improvement/standards
  • Artificial Intelligence
  • Teaching Rounds/standards
  • Intensive Care Units/standards
  • Checklist
  • Guideline Adherence/standards
  • Paper
  • Practice Guidelines as Topic/standards
  • Health Status


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