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World J Crit Care Med. Feb 4, 2015; 4(1): 55-61
Published online Feb 4, 2015. doi: 10.5492/wjccm.v4.i1.55
Checklist for early recognition and treatment of acute illness: International collaboration to improve critical care practice
Marija Vukoja, Rahul Kashyap, Srdjan Gavrilovic, Yue Dong, Oguz Kilickaya, Ognjen Gajic
Marija Vukoja, Srdjan Gavrilovic, The Institute for Pulmonary Diseases of Vojvodina Sremska Kamenica, Faculty of Medicine, University of Novi Sad, Sremska Kamenica 21204, Serbia
Rahul Kashyap, Yue Dong, Ognjen Gajic, Mayo Clinic, Rochester, MN 55905, United States
Oguz Kilickaya, Gulhane Military Medical Faculty, 6400 Ankara, Turkey
Author contributions: All listed authors contributed to the design, conception and writing of this paper; the CERTAIN investigators contributed to the development and implementation of CERTAIN in various ICU settings.
Conflict-of-interest: This research has been reviewed by the Mayo Clinic Conflict of Interest Review Board and is being conducted in compliance with Mayo Clinic conflict of interest policies. Mayo Clinic and Dr Gajic hold intellectual property rights and financial conflict of interest in critical care related software tools.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Marija Vukoja, MD, PhD, The Institute for Pulmonary Diseases of Vojvodina Sremska Kamenica, Faculty of Medicine, University of Novi Sad, Put doktora Goldmana 4, 21204 Sremska Kamenica, Serbia. kojicic.marija@gmail.com
Telephone: +381-21-4805202 Fax: +381-21-527960
Received: August 23, 2014
Peer-review started: August 24, 2014
First decision: November 27, 2014
Revised: December 19, 2014
Accepted: January 18, 2015
Article in press: January 20, 2015
Published online: February 4, 2015
Abstract

Processes to ensure world-wide best-practice for critical care delivery are likely to minimize preventable death, disability and costly complications for any healthcare system’s sickest patients, but no large-scale efforts have so far been undertaken towards these goals. The advances in medical informatics and human factors engineering have provided possibility for novel and user-friendly clinical decision support tools that can be applied in a complex and busy hospital setting. To facilitate timely and accurate best-practice delivery in critically ill patients international group of intensive care unit (ICU) physicians and researchers developed a simple decision support tool: Checklist for Early Recognition and Treatment of Acute Illness (CERTAIN). The tool has been refined and tested in high fidelity simulated clinical environment and has been shown to improve performance of clinical providers faced with simulated emergencies. The aim of this international educational intervention is to implement CERTAIN into clinical practice in hospital settings with variable resources (included those in low income countries) and evaluate the impact of the tool on the care processes and patient outcomes. To accomplish our aims, CERTAIN will be uniformly available on either mobile or fixed computing devices (as well as a backup paper version) and applied in a standardized manner in the ICUs of diverse hospitals. To ensure the effectiveness of the proposed intervention, access to CERTAIN is coupled with structured training of bedside ICU providers.

Keywords: Decision support systems, Critical care, Education, Checklists, Medical informatics

Core tip: Important barriers including limited access to educational resources, geographical distance, cost and lack of efficient global infrastructure greatly limit the feasibility of on site educational interventions. To overcome these barriers the international group of intensive care unit (ICU) physicians and researchers developed a simple decision support tool: Checklist for Early Recognition and Treatment of Acute Illness (CERTAIN). CERTAIN is a systematic approach to error prevention with the use of checklists and electronic decision support algorithms. The effectiveness of CERTAIN to improve outcomes and reduce costs will be tested in a stepped wedge cluster before-after trial in ICUs with variable resources across five continents.