Impact of multiprofessional rounds on clinical outcomes in a public ICU in Northwest Brazil

Impact of multiprofessional rounds on clinical outcomes in a public ICU in Northwest Brazil | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Impact of multiprofessional rounds on clinical outcomes in a public ICU in Northwest Brazil Hiago Sousa Bastos, Paula de Carvalho Bacelar, Déborah Lydia Oliveira da Silva, and 7 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6180060/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Daily multiprofessional rounds are increasingly implemented in ICUs to improve patient outcomes through structured decision-making and interdisciplinary collaboration. However, evidence of their impact in resource-limited public ICUs remains scarce. This study evaluates the effect of implementing daily multiprofessional rounds, structured by checklists, on clinical outcomes in a public ICU in Brazil. A retrospective cohort study was conducted between January 2021 and December 2022, including 652 non-COVID-19 patients admitted to the ICU of Hospital Municipal Djalma Marques. Data from 12 months before and after the implementation of a multidisciplinary quality program were analyzed using univariate tests and Pearson correlation. Among 652 patients, 320 were in the pre-rounds group and 332 in the post-rounds group. ICU occupancy remained high (96.5% vs. 100%, p = 0.551), and mean age was similar (46.7 vs. 47.9 years, p = 0.590). The post-intervention group had higher severity (SAPS 3: 39.4 vs. 60.6, p < 0.001), yet standardized mortality was lower (3.6 vs. 0.7, p < 0.001), and mechanical ventilation duration decreased (9.5 vs. 7 days, p = 0.017). SAPS 3 correlated strongly with central venous catheter use (r = 0.731, p < 0.001) and moderately with urinary catheter use (r = 0.599, p = 0.002). Multiprofessional rounds were associated with reduced mortality and shorter mechanical ventilation duration, supporting their benefit in resource-limited settings. Health sciences/Medical research Health sciences/Medical research/Outcomes research Health sciences/Health care/Public health Figures Figure 1 Introduction Patients admitted to Intensive Care Units (ICUs) require complex and specialized care, which must be provided by a multiprofessional team. For care to be delivered efficiently, effective communication among ICU healthcare professionals is essential [ ¹ ] . To systematize and enhance communication efficacy, daily multiprofessional rounds enable the structured exchange of patient care progress, goals, and pending issues in an objective and non-hierarchical manner among all team members [ ² ] . Due to its multiprofessional nature, the ICU requires a broad and collective approach to patient management, ensuring that all healthcare professionals share a common therapeutic goal [ ¹ , ² ] . However, given the multiple demands and potential complications that arise, communication failures among team members are common and can lead to preventable therapeutic errors [ ³ ] . To minimize such failures and delays in critically ill patient care, multiprofessional rounds involving physicians, nurses, physiotherapists, dietitians, dentists, psychologists, pharmacists, speech therapists, and social workers have proven to be effective in the ICU [ ⁴ ] . To make rounds more objective and structured, the use of checklists can be implemented. Checklists are validated tools in the literature with demonstrated effects in reducing the incidence of medical errors and increasing adherence to evidence-based practices among healthcare professionals [ ⁵ ] . These structured lists are used during patient care to reduce omissions and enhance treatment efficiency. Furthermore, studies suggest that checklists provide clinical benefits by being associated with reduced duration of invasive mechanical ventilation (IMV) and lower ICU mortality rates [ ⁵⁻⁷ ] . However, most studies evaluating ICU quality improvement through multiprofessional rounds have been conducted in high-income countries, with fewer studies performed in low- and middle-income countries such as Brazil, which bear approximately 85% of the global burden of severe illnesses [ ⁸ , ⁹ ] . By investigating the impact of implementing checklist-structured multiprofessional rounds in a Brazilian ICU, this study addresses a significant gap in the literature and provides valuable insights for developing more efficient and safer care protocols in resource-limited hospitals. Methods Study design and population. This was a retrospective observational cohort study aimed at evaluating the impact of implementing checklist-structured multiprofessional rounds on the clinical outcomes of patients admitted to the Intensive Care Unit (ICU) of Hospital Municipal Djalma Marques (HMDM) in São Luís, Maranhão, Brazil. This study was conducted due to the scarcity of national and international evidence regarding quality improvement programs in ICUs from low- and middle-income countries, such as Brazil. The study population included all adult patients admitted to the ICU over a two-year period, comprising one year before and one year after the intervention. This timeframe was chosen to assess both the impact of the intervention and the sustainability of its effects. No sample size calculation was performed, as the study adopted a time-based convenience sampling approach. Ethics approval and consent to participate. This study was approved by the Research Ethics Committee of Hospital São Domingos (approval number: 6.482.710, CAAE: 74369723.60000.5085), in accordance with Resolution No. 466/2012 of the Brazilian National Health Council, which exempts the requirement for written informed consent for retrospective studies that do not involve direct interaction with participants. The study was self-funded by the authors. Study period, inclusion, and exclusion criteria. The study population consisted of 652 patients admitted to a general, closed, non-exclusive surgical or cardiological, tertiary ICU with 10 beds, specializing in trauma care and serving as a state referral center for neurocritical patients. Eligibility criteria included adult patients (≥18 years) admitted to the ICU between January 1, 2021, and December 31, 2022, with a length of stay of ≥48 hours and no confirmed COVID-19 infection (RT-PCR or antigen test). Patients who did not meet these criteria, those admitted with suspected brain death, and those receiving exclusive palliative care were excluded. A minimum ICU stay of 48 hours was required to allow proper evaluation of relevant clinical outcomes, as shorter stays might reflect lower-complexity cases or rapid outcomes unrelated to intensive management. COVID-19 patients were excluded due to the uncertainty regarding the disease's short- and long-term impact during the study period, as well as the lack of standardized treatment protocols, which could introduce confounding variables. Additionally, patients with suspected brain death and those under exclusive palliative care were excluded due to their inevitably poor prognosis. Checklist development. The checklist used during rounds [Figure 1] was developed based on critical points suggested by the multiprofessional team through integrated discussion. Each professional group identified key aspects of patient care requiring daily monitoring, resulting in the categorization of 33 discussion items aligned with best practices, subsequently validated by the unit’s quality leadership. Each professional was responsible for marking critical items in the therapeutic plan using one of the following options: Yes (Y), No (N), Contraindicated (CI), Not Applicable (NA), Optimize (O), or Weaning (W). Each team member had the opportunity to explain and discuss their specific care plans, fostering integration and active participation of all professionals. Multiprofessional rounds and checklist implementation. Before the study, there was no prior team training regarding the importance of multiprofessional rounds in ICU management. Before implementing the intervention, institutional and unit protocols were reviewed and disseminated through periodic meetings with the staff. As part of the quality improvement process, multiprofessional rounds were established following team training, ensuring daily participation of the attending physician, ICU nurse, physiotherapist, unit dietitian, speech therapist, psychologist, social worker, and clinical pharmacist. Rounds were conducted daily at a fixed morning time, covering all 10 ICU beds. The checklist was used to objectively document each team member's proposals and align the overall therapeutic plan for each patient. Meetings took place in the ICU conference room from Monday to Friday, lasted approximately one hour, and allowed full visibility of all beds. The attending physician led and concluded the discussions. Each team member was responsible for completing and verbalizing patient goals and pending issues. At the end of each session, the checklist was collected and signed by all participating professionals. Throughout the study period, physicians, nurses, physiotherapists, dietitians, pharmacists, and social workers had full attendance, ensuring 100% participation from these professionals. Data Collection, Variables, and Database. The EPIMED Monitor® system database was used, following data integrity verification. Data were extracted by the ICU medical coordinator and the study’s principal author, ensuring patient confidentiality and data protection. The database included variables such as sex, age, comorbidities, primary diagnosis, Simplified Acute Physiology Score (SAPS 3), need for and duration of IMV, use and duration of invasive devices (central venous catheter [CVC] and indwelling urinary catheter [IUC]), ICU length of stay, and standardized mortality rate (SMR). Patient data were collected exclusively through medical record review and recorded in a structured form, specifically designed for this study, before being transferred to an electronic database. No patient identification was included, ensuring complete confidentiality. Database organization, statistical analysis, and the generation of tables and graphs were performed using IBM SPSS Statistics v.25.0 (Armonk, NY: IBM Corp®) and Google Sheets®. Statistical Analysis. Data were presented as mean and standard deviation for normally distributed variables and as median with interquartile ranges for non-normally distributed variables, as determined by the Shapiro-Wilk normality test. Homogeneity of variances was assessed using Levene’s test. Univariate analyses comparing the pre- and post-implementation periods were performed using Student’s t-test for independent samples or the Mann-Whitney U test, depending on data distribution, with a significance level of 5%. The primary outcomes evaluated included risk-adjusted mortality rate and ICU length of stay, comparing one year before and one year after the implementation of the multiprofessional quality program. Correlations between continuous variables were assessed using Pearson’s ou Spearman’s correlation test to identify significant linear relationships, with statistical significance set at 5%. Results The analysis included 652 non-COVID-19 patients, with 320 in the pre-rounds group and 332 in the post-rounds group. Data were analyzed in aggregated monthly intervals (n = 12 for each period). ICU occupancy remained high in both periods (96.5% pre-rounds vs. 100% post-rounds, p = 0.551), and the mean patient age was similar between groups (46.7 vs. 47.9 years, p = 0.590) [Table 1]. However, patient severity, measured by SAPS 3, was significantly higher in the post-rounds group (39.4 ± 4.88 vs. 60.63 ± 7.45, p < 0.001) [Table 1]. Despite the increased severity in the post-intervention group, the SMR was significantly lower after the implementation of multiprofessional rounds (3.6 vs. 0.7, p < 0.001). Additionally, the mean duration of IMV was reduced from 9.5 to 7 days (p = 0.017). However, there was a significant increase in the number of patient-days using invasive devices in the post-intervention group, including CVC (101.5 vs. 161.3, p = 0.004), IUC (171 vs. 210, p = 0.033), and IMV (140 vs. 155, p = 0.029) [Table 1]. Correlation analysis between SAPS 3 and the use of invasive devices [Table 2] showed a strong positive correlation between SAPS 3 and both CVC duration (r = 0.726, p < 0.001) and CVC utilization rate (r = 0.731, p < 0.001), suggesting that more severely ill patients required prolonged CVC use. Additionally, moderate positive correlations were found between SAPS 3 and both IUC duration (r = 0.667, p < 0.001) and IUC utilization rate (r = 0.599, p = 0.002), indicating an association between higher patient severity and prolonged IUC use. Discussion The reduction in mortality following the implementation of multiprofessional rounds reinforces their effectiveness in improving clinical outcomes for ICU patients, even among those with greater severity. This improvement is likely due to the structured, team-based approach to critical care management, which enhances communication and optimizes patient care¹,⁵. The increase in SAPS 3 scores in the post-intervention group might initially suggest that the mortality reduction was an artifact of the calculation, as SMRs are derived from observed-to-expected death ratios, and a higher denominator naturally leads to a lower SMR. However, the consistency of the collected data and the shift in ICU management following the introduction of intensivists, alongside the structured implementation of multiprofessional rounds, likely contributed to improvements in patient safety culture, care coordination, and overall quality of care. These factors provide a more plausible explanation for the observed mortality reduction, despite the increased clinical complexity of the cases¹⁰. Findings from Barcellos and Chatkin⁶, which showed that checklist-based multiprofessional rounds reduced complications associated with prolonged mechanical ventilation, such as ventilator-associated pneumonia (VAP), align with the present study’s results. The significant decrease in the duration of invasive mechanical ventilation (IMV) suggests that implementing multiprofessional rounds facilitated earlier ventilator weaning, reducing the risk of associated complications. However, the increased use of invasive devices, such as CVCs and IUCs, likely reflects the greater severity of patients in the post-intervention period. The moderate positive correlations between SAPS 3 and both CVC/IUC duration and utilization rates indicate that more severely ill patients required greater invasive support. These findings are consistent with previous studies showing that critically ill patients with higher disease severity are often more dependent on invasive devices for stabilization¹¹. Despite the improvements in mortality and IMV duration, there was no significant reduction in ICU length of stay. This may be attributed to hospital overcrowding, where patients deemed clinically stable for discharge remained in the ICU due to a lack of available beds in general wards. Such delays in patient transfers are common in resource-limited public hospitals, leading to prolonged ICU stays and reduced availability of critical care beds for new admissions⁶,¹². Shorter IMV duration also carries financial implications, particularly in resource-constrained ICUs. Reducing ventilation time can lower hospital costs by minimizing the need for sedatives, gastric protectants, ventilator-related consumables, and maintenance. Moreover, a shorter IMV duration is associated with a reduced incidence of VAP, which is linked to higher 20-day mortality rates and prolonged ICU stays¹³. These findings are consistent with those observed in high-income settings, where multiprofessional rounds complement the advanced technological and pharmaceutical resources available in such facilities⁵. However, in resource-limited ICUs like the one examined in this study, the lack of infrastructure and funding makes efficient coordination and optimization of human resources even more critical. In these settings, multiprofessional rounds become a fundamental tool for improving clinical outcomes. The impact of this intervention is even more relevant when considering previous findings on ICU practices in the state of Maranhão, Brazil. A study by Carvalho et al.¹² reported that only 43.5% of ICUs in the state regularly conducted multiprofessional rounds, with worse outcomes observed in hospitals outside the capital, São Luís. Expanding the implementation of structured rounds in ICUs across Maranhão represents a viable and necessary strategy for improving critical care outcomes in resource-limited hospitals. Conclusion The implementation of daily multiprofessional rounds appears to significantly improve clinical outcomes for ICU patients, even in resource-limited settings. The observed reduction in mortality and IMV duration, despite the unchanged ICU length of stay, underscores the importance of structured interprofessional collaboration in critical care. However, continuous monitoring and protocol revision are necessary to ensure that the benefits of this intervention are not counterbalanced by increased risks associated with prolonged use of invasive devices. Limitations The main limitations of this study include its retrospective design, potential biases, and limited generalizability as it was conducted in a single public ICU. While key professionals were consistently present during rounds, other specialists participated less frequently. Future multicenter prospective studies are needed to validate these findings and assess the broader applicability of multiprofessional rounds. Declarations Data availability. The data used and analyzed in this study are available from the corresponding author upon justified request. Scripts availability. The IBM SPSS Statistics scripts used in this study are available at: https://github.com/vinicciuspereira/Multiprofesssional-Rounds Acknowledgements We would like to express our gratitude to Hospital Municipal Djalma Marques (HMDM) for providing the setting for this study and to the Federal University of Maranhão (UFMA) for its academic support. Our sincere thanks also go to all healthcare professionals involved in the multiprofessional rounds, whose dedication contributed to the success of this research. Author contributions H.S.B. was responsible for the study conception and design, data collection, data interpretation, manuscript drafting, and critical review. P.D.C.B. contributed to the study design, data collection, data interpretation, and manuscript revision. D.L.O.S., J.M.J.P.L., and L.O.A. assisted in data collection, data interpretation, and critical revision. V.F.P. participated in data collection, statistical analysis, and manuscript revision. E.C.R.M. contributed to the study design, statistical analysis, data interpretation, and manuscript review. A.V.D.F. and J.N.N. were involved in the study design, data interpretation, and manuscript review. P.C.L. performed the final critical review of the manuscript. All authors reviewed and approved the final version of the manuscript. Competing interests The authors declare no competing interests. References Maran, E., et al. Adaptação e validação de checklist multidisciplinar para rounds em Unidade de Terapia Intensiva. Texto Contexto Enferm. 31 , e20210358 (2022) Sharma, S., Hashmi, M.F., Friede, R. Interprofessional rounds in the ICU. StatPearls. Treasure Island (FL). 2024. Berg, S. M., Bittner, E. A. Disrupting deficiencies in data delivery and decision-making during daily ICU rounds. Crit. Care Med. 2019; 47 (3):478-479. Teixeira, P. G., et al. Measurable outcomes of quality improvement using a daily quality rounds checklist: two-year prospective analysis of sustainability in a surgical intensive care unit. J. Trauma Acute Care Surg. 2013; 75 ,717-721. doi: 10.1097/TA.0b013e31829d27b6 Vukoja, M., et al. Checklist for early recognition and treatment of acute illness and injury: an exploratory multicenter international quality-improvement study in the ICUs with variable resources. Crit. Care Med. 2021; 49 ,E598–E612. doi: 10.1097/CCM.0000000000004937 Barcellos, R. A., Chatkin, J. M. Impact of a multidisciplinary checklist on the duration of invasive mechanical ventilation and length of ICU stay. J. Bras. Pneumol. 2020; 46 ,e20180261. doi: 10.36416/1806-3756/e20180261 Cao, V., et al. Patient-centered structured interdisciplinary bedside rounds in the medical ICU. Crit. Care Med. 2018; 46 (1):85-92. doi: 10.1097/CCM.0000000000002807 Soares, M., Salluh, J. I. F., Zampieri, F. G., Bozza, F. A., Kurtz, P. M. P. Uma década do estudo ORCHESTRA: características organizacionais, desfechos dos pacientes, desempenho e eficiência no cuidado intensivo. Crit. Care Sci. 2024; 36 ,e20240118en. doi: 10.62675/2965-2774.20240118-pt Vukoja, M., Riviello, E. D., Schultz, M. J. Critical care outcomes in resource-limited settings. Curr. Opin. Crit. Care. 2018; 24 ,421-427. doi: 10.1097/MCC.0000000000000528 Pari, V., Collaboration for Research Implementation, Training in Critical Care, Asia Africa 'CCAA'. Development of a quality indicator set to measure and improve quality of ICU care in low- and middle-income countries. Intensive Care Med. 2022; 48 ,1551-1562. doi: 10.1007/s00134-022-06818-7 Sena, N. S., et al. Hospital infections in the Intensive Care Unit: an integrative review. Res. Soc. Dev. 2022; 11 ,e32591. doi: 10.33448/rsd-v11i10.32591 Carvalho, A. G. R., Moraes, A. P. P., Carvalho, A. C. P., Silva, A. A. M. Quality assessment of adult intensive care services: application of a tool adjusted to the reality of low-income countries. Rev. Bras. Ter. Intensiva. 2019; 31 ,138-146. doi: 10.5935/0103-507X.20190031 Lee, P. T., et al. Which hospital-acquired conditions matter the most in trauma? An evidence-based approach for prioritizing trauma program improvement. J. Trauma Acute Care Surg. 2022; 93 ,446-452. doi: 10.1097/TA.0000000000003645 Tables Table 1. Comparison of clinical variables between the groups one year before and one year after the implementation of daily multiprofessional rounds. Category Pre-rounds (n = 12) Post-rounds (n = 12) p-value Monthly admissions 26,67 ± 7,75 27,67 ± 5,05 0,712 a Patients-days 233 [211-248] 240 [233-244] 0,514 b ICU occupancy rate (%) 96,50 [88,2-102] 100 [95,5-102] 0,551 b Mean age 46,7 [44,2-48,7] 47,9 [42,7-56,1] 0,590 b ICU length of stay (days) 13,24 ± 4,83 12,71 ± 4,17 0,779 a Monthly medical admissions 10 ± 4,57 10,1 ± 4,4 0,928 a Monthly surgical admissions 10 ± 2,69 10 ± 3,60 0,949 a Mean SAPS 3 39,40 ± 4,88 60,63 ± 7,45 < 0,001 a Predicted mortality rate (%) 10,5 [5,5-15,7] 41,5 [27-47] < 0,001 b Mortality Rate (%) 37,0 [30,5-53,2] 35,5 [21,2-42,0] 0,266 b Standardized Mortality Ratio 3,6 [2,4-6,0] 0,7 [0,5-1,4] < 0,001 b Patient-days using CVC 101,5 ± 55,63 161,33 ± 31,90 0,004 a CVC utilization rate (%) 42,92 ± 21,48 67,50 ± 12,51 0,002 a Patient-days using IUC 171 [109-211] 210 [181-220] 0,033 b IUC utilization rate (%) 71,5 [52,7-88,2] 88,0 [77,5-91,5] 0,060 b Patient-days using IMV 140 [85-163] 155 [132-166] 0,219 b IMV utilization rate (%) 55,08 ± 13,98 63,42 ± 10,63 0,115 a IMV Duration (days) 9,5 [8-10] 7 [6-8] 0,017 b ᵃStudent’s t-test for independent samples; ᵇMann-Whitney U test; SAPS 3 - Simplified Acute Physiology Score 3; CVC - Central Venous Catheter; IMV - Invasive Mechanical Ventilation; IUC - Indwelling Urinary Catheter. Table 2. Comparison of correlations between clinical variables. Category Correlation coefficient (r) p-value Correlation strength Mean SAPS 3 and Patient-days Using CVC 0,726 < 0,001 a Strong and positive Mean SAPS 3 and CVC Utilization Rate 0,731 < 0,001 a Strong and positive Mean SAPS 3 and Patient-days Using IUC 0,667 < 0,001 b Moderate and positive Mean SAPS 3 and IUC Utilization Rate 0,599 0,002 b Moderate and positive ᵃPearson’s correlation test; ᵇSpearman’s correlation test; SAPS 3 - Simplified Acute Physiology Score 3; CVC - Central Venous Catheter; IUC - Indwelling Urinary Catheter. Additional Declarations No competing interests reported. Supplementary Files Table1MPRSR.docx Table2MPRSR.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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16:35:50","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":22472,"visible":true,"origin":"","legend":"","description":"","filename":"Table2MPRSR.docx","url":"https://assets-eu.researchsquare.com/files/rs-6180060/v1/1f72de9e38a28cc8e2e39afb.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eImpact of multiprofessional rounds on clinical outcomes in a public ICU in Northwest Brazil\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePatients admitted to Intensive Care Units (ICUs) require complex and specialized care, which must be provided by a multiprofessional team. For care to be delivered efficiently, effective communication among ICU healthcare professionals is essential\u003csup\u003e[\u003c/sup\u003e\u0026sup1;\u003csup\u003e]\u003c/sup\u003e. To systematize and enhance communication efficacy, daily multiprofessional rounds enable the structured exchange of patient care progress, goals, and pending issues in an objective and non-hierarchical manner among all team members\u003csup\u003e[\u003c/sup\u003e\u0026sup2;\u003csup\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eDue to its multiprofessional nature, the ICU requires a broad and collective approach to patient management, ensuring that all healthcare professionals share a common therapeutic goal\u003csup\u003e[\u003c/sup\u003e\u0026sup1;\u003csup\u003e,\u003c/sup\u003e\u0026sup2;\u003csup\u003e]\u003c/sup\u003e. However, given the multiple demands and potential complications that arise, communication failures among team members are common and can lead to preventable therapeutic errors\u003csup\u003e[\u003c/sup\u003e\u0026sup3;\u003csup\u003e]\u003c/sup\u003e. To minimize such failures and delays in critically ill patient care, multiprofessional rounds involving physicians, nurses, physiotherapists, dietitians, dentists, psychologists, pharmacists, speech therapists, and social workers have proven to be effective in the ICU\u003csup\u003e[\u003c/sup\u003e⁴\u003csup\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eTo make rounds more objective and structured, the use of checklists can be implemented. Checklists are validated tools in the literature with demonstrated effects in reducing the incidence of medical errors and increasing adherence to evidence-based practices among healthcare professionals\u003csup\u003e[\u003c/sup\u003e⁵\u003csup\u003e]\u003c/sup\u003e. These structured lists are used during patient care to reduce omissions and enhance treatment efficiency. Furthermore, studies suggest that checklists provide clinical benefits by being associated with reduced duration of invasive mechanical ventilation (IMV) and lower ICU mortality rates\u003csup\u003e[\u003c/sup\u003e⁵⁻⁷\u003csup\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eHowever, most studies evaluating ICU quality improvement through multiprofessional rounds have been conducted in high-income countries, with fewer studies performed in low- and middle-income countries such as Brazil, which bear approximately 85% of the global burden of severe illnesses\u003csup\u003e[\u003c/sup\u003e⁸\u003csup\u003e,\u003c/sup\u003e⁹\u003csup\u003e]\u003c/sup\u003e. By investigating the impact of implementing checklist-structured multiprofessional rounds in a Brazilian ICU, this study addresses a significant gap in the literature and provides valuable insights for developing more efficient and safer care protocols in resource-limited hospitals.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy design and population.\u0026nbsp;\u003c/strong\u003eThis was a retrospective observational cohort study aimed at evaluating the impact of implementing checklist-structured multiprofessional rounds on the clinical outcomes of patients admitted to the Intensive Care Unit (ICU) of Hospital Municipal Djalma Marques (HMDM) in S\u0026atilde;o Lu\u0026iacute;s, Maranh\u0026atilde;o, Brazil. This study was conducted due to the scarcity of national and international evidence regarding quality improvement programs in ICUs from low- and middle-income countries, such as Brazil.\u003c/p\u003e\n\u003cp\u003eThe study population included all adult patients admitted to the ICU over a two-year period, comprising one year before and one year after the intervention. This timeframe was chosen to assess both the impact of the intervention and the sustainability of its effects. No sample size calculation was performed, as the study adopted a time-based convenience sampling approach.\u003c/p\u003e\n\u003cp\u003eEthics approval and consent to participate.\u0026nbsp;This study was approved by the Research Ethics Committee of Hospital S\u0026atilde;o Domingos (approval number: 6.482.710, CAAE: 74369723.60000.5085), in accordance with Resolution No. 466/2012 of the Brazilian National Health Council, which exempts the requirement for written informed consent for retrospective studies that do not involve direct interaction with participants. The study was self-funded by the authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy period, inclusion, and exclusion criteria.\u0026nbsp;\u003c/strong\u003eThe study population consisted of 652 patients admitted to a general, closed, non-exclusive surgical or cardiological, tertiary ICU with 10 beds, specializing in trauma care and serving as a state referral center for neurocritical patients. Eligibility criteria included adult patients (\u0026ge;18 years) admitted to the ICU between January 1, 2021, and December 31, 2022, with a length of stay of \u0026ge;48 hours and no confirmed COVID-19 infection (RT-PCR or antigen test). Patients who did not meet these criteria, those admitted with suspected brain death, and those receiving exclusive palliative care were excluded.\u003c/p\u003e\n\u003cp\u003eA minimum ICU stay of 48 hours was required to allow proper evaluation of relevant clinical outcomes, as shorter stays might reflect lower-complexity cases or rapid outcomes unrelated to intensive management. COVID-19 patients were excluded due to the uncertainty regarding the disease\u0026apos;s short- and long-term impact during the study period, as well as the lack of standardized treatment protocols, which could introduce confounding variables. Additionally, patients with suspected brain death and those under exclusive palliative care were excluded due to their inevitably poor prognosis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eChecklist development.\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eThe checklist used during rounds [Figure 1] was developed based on critical points suggested by the multiprofessional team through integrated discussion. Each professional group identified key aspects of patient care requiring daily monitoring, resulting in the categorization of 33 discussion items aligned with best practices, subsequently validated by the unit\u0026rsquo;s quality leadership.\u003c/p\u003e\n\u003cp\u003eEach professional was responsible for marking critical items in the therapeutic plan using one of the following options: Yes (Y), No (N), Contraindicated (CI), Not Applicable (NA), Optimize (O), or Weaning (W). Each team member had the opportunity to explain and discuss their specific care plans, fostering integration and active participation of all professionals.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMultiprofessional rounds and checklist implementation.\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eBefore the study, there was no prior team training regarding the importance of multiprofessional rounds in ICU management. Before implementing the intervention, institutional and unit protocols were reviewed and disseminated through periodic meetings with the staff. As part of the quality improvement process, multiprofessional rounds were established following team training, ensuring daily participation of the attending physician, ICU nurse, physiotherapist, unit dietitian, speech therapist, psychologist, social worker, and clinical pharmacist.\u003c/p\u003e\n\u003cp\u003eRounds were conducted daily at a fixed morning time, covering all 10 ICU beds. The checklist was used to objectively document each team member\u0026apos;s proposals and align the overall therapeutic plan for each patient. Meetings took place in the ICU conference room from Monday to Friday, lasted approximately one hour, and allowed full visibility of all beds. The attending physician led and concluded the discussions. Each team member was responsible for completing and verbalizing patient goals and pending issues. At the end of each session, the checklist was collected and signed by all participating professionals. Throughout the study period, physicians, nurses, physiotherapists, dietitians, pharmacists, and social workers had full attendance, ensuring 100% participation from these professionals.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Collection, Variables, and Database.\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eThe EPIMED Monitor\u0026reg; system database was used, following data integrity verification. Data were extracted by the ICU medical coordinator and the study\u0026rsquo;s principal author, ensuring patient confidentiality and data protection. The database included variables such as sex, age, comorbidities, primary diagnosis, Simplified Acute Physiology Score (SAPS 3), need for and duration of IMV, use and duration of invasive devices (central venous catheter [CVC] and indwelling urinary catheter [IUC]), ICU length of stay, and standardized mortality rate (SMR).\u003c/p\u003e\n\u003cp\u003ePatient data were collected exclusively through medical record review and recorded in a structured form, specifically designed for this study, before being transferred to an electronic database. No patient identification was included, ensuring complete confidentiality.\u003c/p\u003e\n\u003cp\u003eDatabase organization, statistical analysis, and the generation of tables and graphs were performed using IBM SPSS Statistics v.25.0 (Armonk, NY: IBM Corp\u0026reg;) and Google Sheets\u0026reg;.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical Analysis.\u003c/strong\u003e Data were presented as mean and standard deviation for normally distributed variables and as median with interquartile ranges for non-normally distributed variables, as determined by the Shapiro-Wilk normality test. Homogeneity of variances was assessed using Levene\u0026rsquo;s test.\u003c/p\u003e\n\u003cp\u003eUnivariate analyses comparing the pre- and post-implementation periods were performed using Student\u0026rsquo;s t-test for independent samples or the Mann-Whitney U test, depending on data distribution, with a significance level of 5%. The primary outcomes evaluated included risk-adjusted mortality rate and ICU length of stay, comparing one year before and one year after the implementation of the multiprofessional quality program.\u003c/p\u003e\n\u003cp\u003eCorrelations between continuous variables were assessed using Pearson\u0026rsquo;s ou Spearman\u0026rsquo;s correlation test to identify significant linear relationships, with statistical significance set at 5%.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe analysis included 652 non-COVID-19 patients, with 320 in the pre-rounds group and 332 in the post-rounds group. Data were analyzed in aggregated monthly intervals (n = 12 for each period). ICU occupancy remained high in both periods (96.5% pre-rounds vs. 100% post-rounds, p = 0.551), and the mean patient age was similar between groups (46.7 vs. 47.9 years, p = 0.590) [Table 1]. However, patient severity, measured by SAPS 3, was significantly higher in the post-rounds group (39.4 \u0026plusmn; 4.88 vs. 60.63 \u0026plusmn; 7.45, p \u0026lt; 0.001) [Table 1].\u003c/p\u003e\n\u003cp\u003eDespite the increased severity in the post-intervention group, the SMR was significantly lower after the implementation of multiprofessional rounds (3.6 vs. 0.7, p \u0026lt; 0.001). Additionally, the mean duration of IMV was reduced from 9.5 to 7 days (p = 0.017). However, there was a significant increase in the number of patient-days using invasive devices in the post-intervention group, including CVC (101.5 vs. 161.3, p = 0.004), IUC (171 vs. 210, p = 0.033), and IMV (140 vs. 155, p = 0.029) [Table 1].\u003c/p\u003e\n\u003cp\u003eCorrelation analysis between SAPS 3 and the use of invasive devices [Table 2] showed a strong positive correlation between SAPS 3 and both CVC duration (r = 0.726, p \u0026lt; 0.001) and CVC utilization rate (r = 0.731, p \u0026lt; 0.001), suggesting that more severely ill patients required prolonged CVC use. Additionally, moderate positive correlations were found between SAPS 3 and both IUC duration (r = 0.667, p \u0026lt; 0.001) and IUC utilization rate (r = 0.599, p = 0.002), indicating an association between higher patient severity and prolonged IUC use.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe reduction in mortality following the implementation of multiprofessional rounds reinforces their effectiveness in improving clinical outcomes for ICU patients, even among those with greater severity. This improvement is likely due to the structured, team-based approach to critical care management, which enhances communication and optimizes patient care\u0026sup1;,⁵.\u003c/p\u003e \u003cp\u003eThe increase in SAPS 3 scores in the post-intervention group might initially suggest that the mortality reduction was an artifact of the calculation, as SMRs are derived from observed-to-expected death ratios, and a higher denominator naturally leads to a lower SMR. However, the consistency of the collected data and the shift in ICU management following the introduction of intensivists, alongside the structured implementation of multiprofessional rounds, likely contributed to improvements in patient safety culture, care coordination, and overall quality of care. These factors provide a more plausible explanation for the observed mortality reduction, despite the increased clinical complexity of the cases\u0026sup1;⁰.\u003c/p\u003e \u003cp\u003eFindings from Barcellos and Chatkin⁶, which showed that checklist-based multiprofessional rounds reduced complications associated with prolonged mechanical ventilation, such as ventilator-associated pneumonia (VAP), align with the present study\u0026rsquo;s results. The significant decrease in the duration of invasive mechanical ventilation (IMV) suggests that implementing multiprofessional rounds facilitated earlier ventilator weaning, reducing the risk of associated complications.\u003c/p\u003e \u003cp\u003eHowever, the increased use of invasive devices, such as CVCs and IUCs, likely reflects the greater severity of patients in the post-intervention period. The moderate positive correlations between SAPS 3 and both CVC/IUC duration and utilization rates indicate that more severely ill patients required greater invasive support. These findings are consistent with previous studies showing that critically ill patients with higher disease severity are often more dependent on invasive devices for stabilization\u0026sup1;\u0026sup1;.\u003c/p\u003e \u003cp\u003eDespite the improvements in mortality and IMV duration, there was no significant reduction in ICU length of stay. This may be attributed to hospital overcrowding, where patients deemed clinically stable for discharge remained in the ICU due to a lack of available beds in general wards. Such delays in patient transfers are common in resource-limited public hospitals, leading to prolonged ICU stays and reduced availability of critical care beds for new admissions⁶,\u0026sup1;\u0026sup2;.\u003c/p\u003e \u003cp\u003eShorter IMV duration also carries financial implications, particularly in resource-constrained ICUs. Reducing ventilation time can lower hospital costs by minimizing the need for sedatives, gastric protectants, ventilator-related consumables, and maintenance. Moreover, a shorter IMV duration is associated with a reduced incidence of VAP, which is linked to higher 20-day mortality rates and prolonged ICU stays\u0026sup1;\u0026sup3;.\u003c/p\u003e \u003cp\u003eThese findings are consistent with those observed in high-income settings, where multiprofessional rounds complement the advanced technological and pharmaceutical resources available in such facilities⁵. However, in resource-limited ICUs like the one examined in this study, the lack of infrastructure and funding makes efficient coordination and optimization of human resources even more critical. In these settings, multiprofessional rounds become a fundamental tool for improving clinical outcomes.\u003c/p\u003e \u003cp\u003eThe impact of this intervention is even more relevant when considering previous findings on ICU practices in the state of Maranh\u0026atilde;o, Brazil. A study by Carvalho et al.\u0026sup1;\u0026sup2; reported that only 43.5% of ICUs in the state regularly conducted multiprofessional rounds, with worse outcomes observed in hospitals outside the capital, S\u0026atilde;o Lu\u0026iacute;s. Expanding the implementation of structured rounds in ICUs across Maranh\u0026atilde;o represents a viable and necessary strategy for improving critical care outcomes in resource-limited hospitals.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe implementation of daily multiprofessional rounds appears to significantly improve clinical outcomes for ICU patients, even in resource-limited settings. The observed reduction in mortality and IMV duration, despite the unchanged ICU length of stay, underscores the importance of structured interprofessional collaboration in critical care. However, continuous monitoring and protocol revision are necessary to ensure that the benefits of this intervention are not counterbalanced by increased risks associated with prolonged use of invasive devices.\u003c/p\u003e"},{"header":"Limitations","content":"\u003cp\u003eThe main limitations of this study include its retrospective design, potential biases, and limited generalizability as it was conducted in a single public ICU. While key professionals were consistently present during rounds, other specialists participated less frequently. Future multicenter prospective studies are needed to validate these findings and assess the broader applicability of multiprofessional rounds.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eData availability.\u0026nbsp;\u003c/strong\u003eThe data used and analyzed in this study are available from the corresponding author upon justified request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eScripts availability.\u0026nbsp;\u003c/strong\u003eThe IBM SPSS Statistics scripts used in this study are available at: https://github.com/vinicciuspereira/Multiprofesssional-Rounds\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to express our gratitude to Hospital Municipal Djalma Marques (HMDM) for providing the setting for this study and to the Federal University of Maranh\u0026atilde;o (UFMA) for its academic support. Our sincere thanks also go to all healthcare professionals involved in the multiprofessional rounds, whose dedication contributed to the success of this research.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eH.S.B. was responsible for the study conception and design, data collection, data interpretation, manuscript drafting, and critical review. P.D.C.B. contributed to the study design, data collection, data interpretation, and manuscript revision. D.L.O.S., J.M.J.P.L., and L.O.A. assisted in data collection, data interpretation, and critical revision. V.F.P. participated in data collection, statistical analysis, and manuscript revision. E.C.R.M. contributed to the study design, statistical analysis, data interpretation, and manuscript review. A.V.D.F. and J.N.N. were involved in the study design, data interpretation, and manuscript review. P.C.L. performed the final critical review of the manuscript. All authors reviewed and approved the final version of the manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col start=\"1\" type=\"1\"\u003e\n \u003cli\u003eMaran, E., et al. Adapta\u0026ccedil;\u0026atilde;o e valida\u0026ccedil;\u0026atilde;o de checklist multidisciplinar para rounds em Unidade de Terapia Intensiva. \u003cem\u003eTexto Contexto Enferm.\u003c/em\u003e \u003cstrong\u003e31\u003c/strong\u003e, e20210358 (2022)\u003c/li\u003e\n \u003cli\u003eSharma, S., Hashmi, M.F., Friede, R. Interprofessional rounds in the ICU. \u003cem\u003eStatPearls.\u003c/em\u003e Treasure Island (FL). 2024.\u003c/li\u003e\n \u003cli\u003eBerg, S. M., Bittner, E. A. Disrupting deficiencies in data delivery and decision-making during daily ICU rounds. \u003cem\u003eCrit. Care Med.\u003c/em\u003e 2019;\u003cstrong\u003e47\u003c/strong\u003e(3):478-479.\u003c/li\u003e\n \u003cli\u003eTeixeira, P. G., et al. Measurable outcomes of quality improvement using a daily quality rounds checklist: two-year prospective analysis of sustainability in a surgical intensive care unit. \u003cem\u003eJ. Trauma Acute Care Surg.\u003c/em\u003e 2013;\u003cstrong\u003e75\u003c/strong\u003e,717-721. doi: 10.1097/TA.0b013e31829d27b6\u003c/li\u003e\n \u003cli\u003eVukoja, M., et al. Checklist for early recognition and treatment of acute illness and injury: an exploratory multicenter international quality-improvement study in the ICUs with variable resources. \u003cem\u003eCrit. Care Med.\u003c/em\u003e 2021;\u003cstrong\u003e49\u003c/strong\u003e,E598\u0026ndash;E612. doi: 10.1097/CCM.0000000000004937\u003c/li\u003e\n \u003cli\u003eBarcellos, R. A., Chatkin, J. M. Impact of a multidisciplinary checklist on the duration of invasive mechanical ventilation and length of ICU stay. \u003cem\u003eJ. Bras. Pneumol.\u003c/em\u003e 2020;\u003cstrong\u003e46\u003c/strong\u003e,e20180261. doi: 10.36416/1806-3756/e20180261\u003c/li\u003e\n \u003cli\u003eCao, V., et al. Patient-centered structured interdisciplinary bedside rounds in the medical ICU. \u003cem\u003eCrit. Care Med.\u003c/em\u003e 2018;\u003cstrong\u003e46\u003c/strong\u003e(1):85-92. doi: 10.1097/CCM.0000000000002807\u003c/li\u003e\n \u003cli\u003eSoares, M., Salluh, J. I. F., Zampieri, F. G., Bozza, F. A., Kurtz, P. M. P. Uma d\u0026eacute;cada do estudo ORCHESTRA: caracter\u0026iacute;sticas organizacionais, desfechos dos pacientes, desempenho e efici\u0026ecirc;ncia no cuidado intensivo. \u003cem\u003eCrit. Care Sci.\u003c/em\u003e 2024;\u003cstrong\u003e36\u003c/strong\u003e,e20240118en. doi: 10.62675/2965-2774.20240118-pt\u003c/li\u003e\n \u003cli\u003eVukoja, M., Riviello, E. D., Schultz, M. J. Critical care outcomes in resource-limited settings. \u003cem\u003eCurr. Opin. Crit. Care.\u003c/em\u003e 2018;\u003cstrong\u003e24\u003c/strong\u003e,421-427. doi: 10.1097/MCC.0000000000000528\u003c/li\u003e\n \u003cli\u003ePari, V., Collaboration for Research Implementation, Training in Critical Care, Asia Africa \u0026apos;CCAA\u0026apos;. Development of a quality indicator set to measure and improve quality of ICU care in low- and middle-income countries. \u003cem\u003eIntensive Care Med.\u003c/em\u003e 2022;\u003cstrong\u003e48\u003c/strong\u003e,1551-1562. doi: 10.1007/s00134-022-06818-7\u003c/li\u003e\n \u003cli\u003eSena, N. S., et al. Hospital infections in the Intensive Care Unit: an integrative review. \u003cem\u003eRes. Soc. Dev.\u003c/em\u003e 2022;\u003cstrong\u003e11\u003c/strong\u003e,e32591. doi: 10.33448/rsd-v11i10.32591\u003c/li\u003e\n \u003cli\u003eCarvalho, A. G. R., Moraes, A. P. P., Carvalho, A. C. P., Silva, A. A. M. Quality assessment of adult intensive care services: application of a tool adjusted to the reality of low-income countries. \u003cem\u003eRev. Bras. Ter. Intensiva.\u003c/em\u003e 2019;\u003cstrong\u003e31\u003c/strong\u003e,138-146. doi: 10.5935/0103-507X.20190031\u003c/li\u003e\n \u003cli\u003eLee, P. T., et al. Which hospital-acquired conditions matter the most in trauma? An evidence-based approach for prioritizing trauma program improvement. \u003cem\u003eJ. Trauma Acute Care Surg.\u003c/em\u003e 2022;\u003cstrong\u003e93\u003c/strong\u003e,446-452. doi: 10.1097/TA.0000000000003645\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1.\u0026nbsp;\u003c/strong\u003eComparison of clinical variables between the groups one year before and one year after the implementation of daily multiprofessional rounds.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"600\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 231px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategory\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePre-rounds (n = 12)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePost-rounds (n = 12)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 231px;\"\u003e\n \u003cp\u003eMonthly admissions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e26,67 \u0026plusmn; 7,75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003e27,67 \u0026plusmn; 5,05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e0,712\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 231px;\"\u003e\n \u003cp\u003ePatients-days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e233 [211-248]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003e240 [233-244]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e0,514\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 231px;\"\u003e\n \u003cp\u003eICU occupancy rate (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e96,50 [88,2-102]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003e100 [95,5-102]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e0,551\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 231px;\"\u003e\n \u003cp\u003eMean age\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e46,7 [44,2-48,7]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003e47,9 [42,7-56,1]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e0,590\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 231px;\"\u003e\n \u003cp\u003eICU length of stay (days)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e13,24 \u0026plusmn; 4,83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003e12,71 \u0026plusmn; 4,17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e0,779\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 231px;\"\u003e\n \u003cp\u003eMonthly medical admissions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e10 \u0026plusmn; 4,57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003e10,1 \u0026plusmn; 4,4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e0,928\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 231px;\"\u003e\n \u003cp\u003eMonthly surgical admissions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e10 \u0026plusmn; 2,69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003e10 \u0026plusmn; 3,60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e0,949\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 231px;\"\u003e\n \u003cp\u003eMean SAPS 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e39,40 \u0026plusmn; 4,88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003e60,63 \u0026plusmn; 7,45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026lt; 0,001\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 231px;\"\u003e\n \u003cp\u003ePredicted mortality rate (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e10,5 [5,5-15,7]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003e41,5 [27-47]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026lt; 0,001\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 231px;\"\u003e\n \u003cp\u003eMortality Rate (%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e37,0 [30,5-53,2]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003e35,5 [21,2-42,0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e0,266\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 231px;\"\u003e\n \u003cp\u003eStandardized Mortality Ratio \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e3,6 [2,4-6,0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003e0,7 [0,5-1,4]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026lt; 0,001\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 231px;\"\u003e\n \u003cp\u003ePatient-days using CVC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e101,5 \u0026plusmn; 55,63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003e161,33 \u0026plusmn; 31,90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e0,004\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 231px;\"\u003e\n \u003cp\u003eCVC utilization rate (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e42,92 \u0026plusmn; 21,48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003e67,50 \u0026plusmn; 12,51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e0,002\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 231px;\"\u003e\n \u003cp\u003ePatient-days using IUC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e171 [109-211]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003e210 [181-220]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e0,033\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 231px;\"\u003e\n \u003cp\u003eIUC utilization rate (%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e71,5 [52,7-88,2]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003e88,0 [77,5-91,5]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e0,060\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 231px;\"\u003e\n \u003cp\u003ePatient-days using IMV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e140 [85-163]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003e155 [132-166]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e0,219\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 231px;\"\u003e\n \u003cp\u003eIMV utilization rate (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e55,08 \u0026plusmn; 13,98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003e63,42 \u0026plusmn; 10,63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e0,115\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 231px;\"\u003e\n \u003cp\u003eIMV Duration (days)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e9,5 [8-10]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003e7 [6-8]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e0,017\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eᵃStudent\u0026rsquo;s t-test for independent samples; ᵇMann-Whitney U test; SAPS 3 - Simplified Acute Physiology Score 3; CVC - Central Venous Catheter; IMV - Invasive Mechanical Ventilation; IUC - Indwelling Urinary Catheter.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2.\u003c/strong\u003e Comparison of correlations between clinical variables.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"609\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 248px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategory\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 167px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCorrelation coefficient (r)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 136px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCorrelation strength\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 248px;\"\u003e\n \u003cp\u003eMean SAPS 3 and Patient-days Using CVC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 167px;\"\u003e\n \u003cp\u003e0,726\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026lt; 0,001\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 136px;\"\u003e\n \u003cp\u003eStrong and positive\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 248px;\"\u003e\n \u003cp\u003eMean SAPS 3 and CVC Utilization Rate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 167px;\"\u003e\n \u003cp\u003e0,731\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026lt; 0,001\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 136px;\"\u003e\n \u003cp\u003eStrong and positive\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 248px;\"\u003e\n \u003cp\u003eMean SAPS 3 and Patient-days Using IUC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 167px;\"\u003e\n \u003cp\u003e0,667\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026lt; 0,001\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 136px;\"\u003e\n \u003cp\u003eModerate and positive\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 248px;\"\u003e\n \u003cp\u003eMean SAPS 3 and IUC Utilization Rate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 167px;\"\u003e\n \u003cp\u003e0,599\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e0,002\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 136px;\"\u003e\n \u003cp\u003eModerate and positive\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eᵃPearson\u0026rsquo;s correlation test; ᵇSpearman\u0026rsquo;s correlation test; SAPS 3 - Simplified Acute Physiology Score 3; CVC - Central Venous Catheter; IUC - Indwelling Urinary Catheter.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-6180060/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6180060/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eDaily multiprofessional rounds are increasingly implemented in ICUs to improve patient outcomes through structured decision-making and interdisciplinary collaboration. However, evidence of their impact in resource-limited public ICUs remains scarce. This study evaluates the effect of implementing daily multiprofessional rounds, structured by checklists, on clinical outcomes in a public ICU in Brazil. A retrospective cohort study was conducted between January 2021 and December 2022, including 652 non-COVID-19 patients admitted to the ICU of Hospital Municipal Djalma Marques. Data from 12 months before and after the implementation of a multidisciplinary quality program were analyzed using univariate tests and Pearson correlation. Among 652 patients, 320 were in the pre-rounds group and 332 in the post-rounds group. ICU occupancy remained high (96.5% vs. 100%, p\u0026thinsp;=\u0026thinsp;0.551), and mean age was similar (46.7 vs. 47.9 years, p\u0026thinsp;=\u0026thinsp;0.590). The post-intervention group had higher severity (SAPS 3: 39.4 vs. 60.6, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), yet standardized mortality was lower (3.6 vs. 0.7, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and mechanical ventilation duration decreased (9.5 vs. 7 days, p\u0026thinsp;=\u0026thinsp;0.017). SAPS 3 correlated strongly with central venous catheter use (r\u0026thinsp;=\u0026thinsp;0.731, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and moderately with urinary catheter use (r\u0026thinsp;=\u0026thinsp;0.599, p\u0026thinsp;=\u0026thinsp;0.002). Multiprofessional rounds were associated with reduced mortality and shorter mechanical ventilation duration, supporting their benefit in resource-limited settings.\u003c/p\u003e","manuscriptTitle":"Impact of multiprofessional rounds on clinical outcomes in a public ICU in Northwest Brazil","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-03-17 16:19:45","doi":"10.21203/rs.3.rs-6180060/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"cc363fcf-aba7-4281-b55b-8b8de9d2a020","owner":[],"postedDate":"March 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":45667182,"name":"Health sciences/Medical research"},{"id":45667183,"name":"Health sciences/Medical research/Outcomes research"},{"id":45667184,"name":"Health sciences/Health care/Public health"}],"tags":[],"updatedAt":"2025-03-18T05:08:27+00:00","versionOfRecord":[],"versionCreatedAt":"2025-03-17 16:19:45","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6180060","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6180060","identity":"rs-6180060","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}