Enhancing ICU Quality Metrics Through a Multidisciplinary Daily Checklist Integrated in the EHR

Sunday, March 22, 2026

9:45 AM - 10:45 AM Central Time

Location: Connections Central - RST 01

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Farid Sadaka, MD

Mercy Heart and Vascular Hospital St. Louis, Missouri

Disclosure(s): No relevant financial relationship(s) to disclose.
Vinaya R. Sermadevi, MD (she/her/hers)

Mercy Hospital Saint Louis, Missouri

Disclosure(s): No relevant financial relationship(s) to disclose.
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Anup Katyal, MD

Mercy Hospital Saint Louis

Disclosure information not submitted.
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Walter Mickey, DO

Saint Johns Mercy Hospital

Disclosure information not submitted.
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Chaitanya Karlapalem, MD

MERCY HOSPITAL, Missouri

Disclosure(s): No relevant financial relationship(s) to disclose.
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Cody Novack, MD

Critical Care Fellow
Mercy Hospital St Louis/St Louis University, Missouri

Disclosure information not submitted.
JP

Jen Pipkin, RN

EDON
Mercy Hospital St Louis

Disclosure information not submitted.
RD

Rachel Dutton, RN

RN
Mercy Hospital St Louis

Disclosure information not submitted.
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kelsey Kyle, RN

RN
Mercy Hospital St Louis

Disclosure information not submitted.
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Elizabeth Glidewell, RN

RN
Mercy Hospital St Louis

Disclosure information not submitted.
PL

Patrick Luecke, RN

CVICU Manager
Mercy Hospital St Louis

Disclosure information not submitted.
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Mary McCoy, RN

Neuro-Trauma ICU Manager
Mercy Hospital St Louis

Disclosure information not submitted.
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Stefanie Struckhoff, RN

MSICU Manager
Mercy Hospital St Louis

Disclosure information not submitted.
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Kayla Leon, APP

APP
Mercy Hospital St Louis

Disclosure information not submitted.
JP

John Ponzillo, PharmD

PharmD
Mercy Hospital St Louis

Disclosure information not submitted.
CA

Carly Augsburger, PharmD

PharmD
Mercy Hospital St Louis

Disclosure information not submitted.
DL

Danny Lutz, RRT

RRT Director
Mercy Hospital St Louis

Disclosure information not submitted.
JK

Joe Kowalczyk, RRT

RRT
Mercy Hospital St Louis

Disclosure information not submitted.
KF

Kim Fowler, BSN, RN

RN
Mercy Hospital Saint Louis

Disclosure information not submitted.

Introduction: High-quality, standardized care in the Intensive Care Unit (ICU) is essential for improving patient outcomes, reducing variability in practice, and enhancing adherence to evidence-based guidelines. We implemented a structured, multidisciplinary daily checklist embedded in the EPIC Electronic Health Record (EHR). The checklist was designed to streamline clinical decision-making, reinforce best practices, and ensure accountability by documenting key interventions as part of the daily note.

Methods: Beginning in June 2024, the checklist was completed each day during multidisciplinary ICU rounds by the attending physician, registered nurse (RN), fellow, pharmacist (PharmD), and respiratory therapist (RT), and entered into the patient's chart. We performed a retrospective comparison of two time periods: January–May 2024 (pre-intervention) and January–May 2025 (post-intervention). Key process metrics included spontaneous awakening trial (SAT), Confusion Assessment Method for the ICU (CAM-ICU), spontaneous breathing trial (SBT), nutrition initiation, and timing of transfer orders. Clinical outcomes included ICU length of stay (LOS) and catheter-associated urinary tract infection (CAUTI) metrics, specifically the Standardized Utilization Ratio (SUR) and Standardized Infection Ratio (SIR), as defined by the National Healthcare Safety Network (NHSN).

Results: Implementation of the checklist led to statistically significant improvements: SAT completion increased from 1.6% (n = 3268) to 7% (n = 1800) (p = 0.0001), CAM-ICU documentation from 17% (n = 8442) to 45% (n = 5396) (p = 0.0001), SBT from 20 % (n = 1500) to 25 % (n = 1400) (p = 0.001), Nutrition ordered and given from 72% (n = 7400) to 75% (n = 4736) (p = 0.0003), Transfer orders before 10 AM from 33% (n = 3000) to 72% (n = 2800) (p = 0.0001), with an associated reduction in ICU LOS from 7.2 to 4.0 days (p = 0.0001); Foley catheter SUR decreased from 0.62 to 0.36 (p = 0.001), and CAUTI SIR dropped from 1.1 to 0.39 (p = 0.0001).

Conclusions: The integration of a multidisciplinary checklist into the daily ICU workflow, documented within the EHR, significantly enhanced compliance with evidence-based practices. These improvements were associated with better clinical outcomes, including shorter ICU stays and reduced catheter-associated infection rates.