A quality-improvement intervention with remote simulation training to implement a decision support tool was associated with decreased nonadherence to daily care processes, shorter length of stay, and decreased mortality.

The coprimary outcomes, modified from the original protocol before data analysis, were nonadherence to 10 basic care processes and ICU and hospital length of stay.

There were 1,447 patients in the preimplementation phase and 2,809 patients in the postimplementation phase.

After adjusting for center effect, Checklist for Early Recognition and Treatment of Acute Illness and Injury implementation was associated with reduced nonadherence to care processes: deep vein thrombosis prophylaxis, peptic ulcer prophylaxis, spontaneous breathing trial, family conferences, and daily assessment for the need of central venous catheters, urinary catheters, antimicrobials, and sedation.

This before-after study was performed in 34 ICUs (15 countries) from 2013 to 2017.

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