Pragmatic Disease-Focused Checklist for Use During Rounding on Critically Ill Patients With COVID-19

Somnath Bose, MD; Akiva Leibowitz, MD

Disclosures

Am J Crit Care. 2021;30(3):238-241. 

In This Article

Abstract and Introduction

Abstract

The sudden surge in cases of COVID-19 has presented unprecedented challenges in the care of critically ill patients with the disease. A disease-focused checklist was developed to supplement and streamline the existing structure of rounds during a time of significant resource constraint. A total of 51 critical care consultants across multiple specialties at a tertiary academic medical center were surveyed regarding their preference for a structured checklist. Among the respondents, 82% were in favor of a disease-focused checklist. Mechanical ventilation parameters, rescue ventilation strategies, sedation regimens, inflammatory markers specific to COVID-19, and family communication were the elements most commonly identified as being important for inclusion in such a checklist.

Introduction

The COVID-19 pandemic has presented significant challenges to health care systems worldwide, as approximately 14.4% to 16% of those hospitalized require admission to an intensive care unit (ICU).[1,2] The rapid evolution of this pandemic has strained ICU capacities to unprecedented levels.[3,4] Uncommon circumstances such as need for surge ICU space, reallocation of nursing staff, and the accompanying multiple care transitions continue to present unique challenges to well-established ICU workflows.[3]

These issues have been compounded by uncertainties about the natural history of the disease and a lack of established treatment guidelines.[5] Such uncertainties notwithstanding, certain clinical patterns have emerged among critically ill patients with COVID-19 who have been admitted to ICUs.[6] Most of these patients arrive in the ICU in a hyperinflammatory, prothrombotic state, with acute respiratory distress syndrome (ARDS) as the key manifestation.

The main problems associated with the care of these patients in the ICU that are distinct from the problems that arise during usual care include difficulties with mechanical ventilation with frequent need for rescue strategies, challenges with management of sedatives and anticoagulants, selection of therapeutics for off-label use, and restrictions on family visitation, which hinder communication. Recognizing these clinical patterns, we sought to ascertain whether intensivists would be interested and perceive utility in the development of a disease-focused checklist that would streamline and supplement the existing structure of rounds, and we aimed to identify appropriate components of such a checklist. Checklists by themselves may have limited utility in improving quality of care,[7] but their role in the management of a relatively new disease when major logistical challenges abound has not been explored.

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