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Review of System (ROS)
Review of System (ROS)
Principal investigator
Co-investigators
Mentor
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Application Of The Review Of System (ROS) Protocol In The ICU And
Its Effect On Patient Outcome and Length And Cost Of Stay
Abdul Hamid Alraiyes M.D., Manju Pillai M.D., Samer Alhindi M.D., Khalid Alokla M.D., Joseph Sopko MD, FCCP
ABSTRACT
PURPOSE
The purpose of this study is to assess the impact of daily round checklist using Review of System (ROS) protocol in
an open ICU system on patient‟s outcome plus length and cost of stay.
METHODS
Over 4 months 81 patients with APACHE II (Acute Phase and Chronic Health Evaluation II) score ≥ 20 were
admitted to ICU and randomly distributed to three on-call groups per call schedule; the (ROS) protocol was applied
on one ICU team while the other two teams didn‟t use the (ROS); the three groups studied looking at APACHE II
score at 24 hrs and 48 hrs, cost of the stay in the ICU and length of stay (LOS) in the ICU. Data collected were
analyzed using ANOVA analysis in order to compare the differences between the 3 groups in the APACHE II score
at 24 vs. 48 hrs, the ICU cost and length of stay.
RESULTS
Admissions to ICU with APACHE II score ≥ 20 were randomly distributed to the three groups of residents per the
call schedule and the (ROS) protocol was used by one ICU team. By using the APPACHE II score as an indicator
for clinical improvement and patient illness prognosis (outcome), the change of this score in 24 and 48 hours was
statistically significant with P-value 0.005 comparing to other residents teams that didn‟t utilize the ROS protocol.
ANOVA analysis didn‟t show a statistically significant reduction neither in cost nor length of stay.
CONCLUSION
ROS checklist is a useful tool that improves outcome and reduce human errors in many industrial carriers such as
aviation. We showed that Review of System (ROS) protocol is a tool that can organize orders on admission and
daily round in open ICU system and improve sick patients‟ outcome. This protocol may shorten the stay in the ICU
and lower the cost of stay.
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Two out of six interventions from the 100,000 Lives randomly distributed to three on-call groups per
Campaign which applied by the institute of healthcare monthly call schedule; the (ROS) protocol was applied
improvement are Prevention of Central Line Infections on one ICU team‟s patient were the other two teams
and Ventilator-Associated Pneumonia which proved to didn‟t use the (ROS) protocol; the three groups were
save 100K lives6 . compared based on APACHE II score at 24 hrs and 48
hrs, cost and length of stay (LOS) in the ICU. Our
Review Of Systems (ROS) protocol (figure1) “see the hypothesis is to find a difference in the mean of the
attached protocol” is simply a check list used on above collected data between the (ROS) group of
admission and daily ICU rounds that adapted the patients and the other 2 groups.
principles from above tools which applied in open ICU
system with no 24/7 in-house intensivist coverage7. Data collected were analyzed using multi-way
ANOVA analysis in order to compare the difference
between the 3 groups in the APACHE II score at 24 vs.
(Figure 1) 48 hrs, the ICU cost and length of stay. Box plot
graphics done for each variable and P value calculated.
Patients‟ age and APACHE II score on admission were
equal in the (ROS) group and control groups (table 1).
RESULTS
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(Figure 2)
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subspecialty staff, nurses and respiratory therapists that wasn‟t statistically significant because of the lack
before utilizing it in our ICU. This approach was made of 24/7 intensivist in our ICU7 which delay patient‟s
to cover all significant points that affect patient transfer to regular nursing floor until daily morning
outcome, plan of care and above all coordination round done by the primary care physician14 who will
between all teams. make the transfer decision.
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