Article Text

Download PDFPDF
Perceptions of rounding checklists in the intensive care unit: a qualitative study
  1. Bethany Danae Hallam1,2,
  2. Courtney C Kuza2,
  3. Kimberly Rak2,
  4. Jessica C Fleck2,
  5. Melanie M Heuston3,
  6. Debjit Saha3,
  7. Jeremy M Kahn2,3
  1. 1 Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
  2. 2 Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
  3. 3 UPMC Health System, Pittsburgh, Pennsylvania, USA
  1. Correspondence to Dr. Jeremy M Kahn; jeremykahn{at}


Background Rounding checklists are an increasingly common quality improvement tool in the intensive care unit (ICU). However, effectiveness studies have shown conflicting results. We sought to understand ICU providers’ perceptions of checklists, as well as barriers and facilitators to effective utilisation of checklists during daily rounds.

Objectives To understand how ICU providers perceive rounding checklists and develop a framework for more effective rounding checklist implementation.

Methods We performed a qualitative study in 32 ICUs within 14 hospitals in a large integrated health system in the USA. We used two complementary data collection methods: direct observation of daily rounds and semistructured interviews with ICU clinicians. Observations and interviews were thematically coded and primary themes were identified using a combined inductive and deductive approach.

Results We conducted 89 interviews and performed 114 hours of observation. Among study ICUs, 12 used checklists and 20 did not. Participants described the purpose of rounding checklists as a daily reminder for evidence-based practices, a tool for increasing shared understanding of patient care across care providers and a way to increase the efficiency of rounds. Checklists were perceived as not helpful when viewed as overstandardising care and when they are not relevant to a particular ICU’s needs. Strategies to improve checklist implementation include attention to the brevity and relevance of the checklist to the particular ICU, consistent use over time, and integration with daily work flow.

Conclusion Our results provide potential insights about why ICU rounding checklists frequently fail to improve outcomes and offer a framework for effective checklist implementation through greater feedback and accountability.

  • checklists
  • critical care
  • communication
  • Quality Improvement

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Funding This study was funded by the Foundation for the National Institutes of Health (K24HL133444, PI: JMK).

  • Competing interests None declared.

  • Patient consent Detail has been removed from this case description/these case descriptions to ensure anonymity. The editors and reviewers have seen the detailed information available and are satisfied that the information backs up the case the authors are making.

  • Ethics approval This work was reviewed and approved as a quality improvement project by the UPMC Quality Improvement Committee. The UPMC Quality Improvement Committee reviews quality improvement projects under the authority of the University of Pittsburgh Human Research Protection Office to ensure that they meet established guidelines for quality improvement.

  • Provenance and peer review Not commissioned; externally peer reviewed.