(1220) Design and Implementation of a Checklist to Prevent Critical Illness in Older Primary Care Patients

Introduction: Older adults are more susceptible to critical illness and are at a higher risk of being admitted to the ICU. Multiple coexisting conditions and atypical presentations lead to under recognition of patients at imminent risk of acute deterioration, leading to poor prognosis. The study objective was to design and implement a checklist for primary care clinicians to facilitate preventive efforts in patients at high risk of ICU admission, as determined by the verified Elder Risk Assessment (ERA) index.

Methods: A checklist was collaboratively designed by a multidisciplinary team including critical care and primary care clinicians at a primary care site in Mayo Clinic MN, to help address actionable risk factors for critical illness in at-risk older (≥60 years old) patients during primary care visits. Two workshops were carried out to design and refine the Checklist. A consensus of items and organization was reached at the end of each workshop session.

The final version of the Checklist was distributed to primary care clinicians between May and July 2023 to pilot in the clinic and used with patients whose ERA score was ≥ 9. Providers were instructed to mark each item on a paper Checklist that prompted an action or assessment that otherwise would not have been done.

Results: 16 primary care clinicians participated in the Checklist design workshops. The final checklist included 38 items grouped in 12 system categories based on best practice guidelines. The Checklist was used in 49/289 (17%) eligible patients ≥ 60 years old with an ERA index ≥9. Twenty-one different providers used the Checklist at least once. The checklist prompted an action or assessment 49% of the time it was used. A post implementation survey conducted with 13 clinician participants showed 77% used the ERA index and 69% used the Checklist.

Conclusions: A collaboratively designed Checklist was piloted in a primary care medicine with reasonable reach for patients at risk of ICU admission. The impact of the actions prompted by the checklist on outcomes among older patients at risk of acute deterioration and ICU admission warrants further investigation.