Dear Editor,

At the bedside, clinical guidelines are fully complied with in 24 % of critically ill patients [1]. The checklist is a document built to increase adhesion to the necessary security procedural steps. First developed in aerospace, it was subsequently used in intensive care units (ICU) with encouraging results [2–4]. Although checklists may reduce omission errors for critically ill patients, their practice is poorly reported. We conducted a French national survey to describe the use of checklists in ICUs. After local ethical approval, all French public sector ICUs (Fédération Hospitalière de France) were directly called by phone. The demographic and specific characteristics of the ICU were obtained from the matron, and the existence of a checklist for 6 following items: central venous catheter insertion, orotracheal intubation or tracheostomy related procedures, in-hospital transfer for critically ill patients, prevention of ventilator-acquired pneumonia (VAP), and weaning from mechanical ventilation. Participation was voluntary. A total of 304 ICUs were called, and 298 (98 %) agreed to participate in the study. Of these, 180 (60 %) were mixed ICUs, 75 (25 %) were surgical ICUs, and 43 (15 %) were medical ICUs. The mean bed capacity was 12 (8–15), and the number of beds per nurse ratio during the day and the night were 2.9 (2.5–3.1) and 3.2 (2.8–3.6), respectively. The prescriptions were computerized in 111 (37 %) ICUs, while 91 (31 %) ICUs offered a computerized nursing supervision. Table 1 describes the checklist use for each item, according to the type of ICU.

Table 1 Description of the checklist use in the ICUs
Full size table

Checklists are used in medicine as a simple tool to increase the quality of care. Our results emphasize that checklists are scarcely used in French ICUs, despite recent publications showing a decrease in morbidity and hospital length of stay [2, 3]. Therefore, increasing the use of checklists is an opportunity to improve ICU care in France.

Moreover, the manner in which checklists are implemented is of great consequence in the care of ICU patients [3]. Their availability is not sufficient, and a validation process seems essential. In our study, we have not found any relationship between the number of beds per nurse and checklist implementation, showing that checklist use in ICU does not seem related to the human costs. Human [3] or computer prompting [5], and simulation training for ICU teams [4] could provide a more effective approach to checklist implementation. The cost impact of checklist implementation was not evaluated in the study. This point could be a limitation for their use.

Our study did not evaluate the clinical impact of those checklists, because the incidences of ICU complications were not recorded. Large studies comparing the impact of checklist use in ICU are mandatory to definitively evaluate the clinical cost/benefit ratio.

In conclusion, checklists are scarcely used in French ICUs. Communication and computer prompting could be developed to improve their implementation.