Clinical Trial

The Checklist for Early Recognition and Treatment of Acute Illness and Injury (CERTAIN) Identifier:  NCT01973829


The care assisted by prompting with decision tool (CERTAIN) will improve the process and outcome of acute critical illness

Design :

Step-wedge,  cluster implementation in diverse, international acute care settings

Primary Outcome Measures:

  • Adherence to best critical care practices
    • Adherence to best practice in initial evaluation and treatment of critically ill medical and surgical patients
    • Appropriate shock resuscitation
    • Appropriate sepsis treatment
    • Appropriate mechanical ventilation
    • Appropriate peptic ulcer, deep vein thrombosis and infectious disease prophylaxis
  • ICU and hospital lengths of stay

Secondary Outcome Measures:

  • Hospital mortality, 28 days mortality, discharge home




  • PI: Marija Kojicic, MD, Institute for Pulmonary Diseases, Novi Sad, Serbia
  • Co- PI and Study Director: Rahul Kashyap, MD, Mayo Clinic, Rochester, Minnesota, USA
  • Co- PI: Joseph (J Christopher) C. Farmer, MD, Mayo Clinic, Scottsdale, Arizona, USA.  (SCCM),  Ognjen Gajic, MD, Mayo Clinic, Rochester, Minnesota, USA (U.S. Critical Illness and Injury Trials  Group)
  • Co- I: Neill Adhikari, MD, University of Toronto, Toronto Canada (ATS International Health Committee)
  • Co- I: Linda Bucher, PhD, College of Health Sciences, University of Delaware, Delaware, USA (AACN)
  • Co- I: Yue Dong, MD, Mayo Clinic, Rochester, Minnesota, USA
  • Co- I: Michelle N Gong, MD, Montefiore Medical Center, New York, New York, USA (U.S. Critical Illness and Injury Trials  Group)
  • Co- I: Oguz Kilickaya, MD, Gulhane Military Medical Faculty, Ankara, Turkey
  • Co- I: Marcus Schultz, MD, VU University of Amsterdam, Holland (ESICM Global Working Group)
  • Co- I: Daniel Talmor, MD, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA (U.S. Critical Illness and Injury Trials  Group)


Mayo Clinic and one or more of the investigators associated with this project have a Financial Conflict of Interest in technology used in the research and the investigators and Mayo Clinic may stand to gain financially from the successful outcome of the research.

In compliance with Mayo Clinic Conflict of Interest policy we are pleased to welcome Dr J Christopher Farmer to the Mayo Team as a non-conflicted principal investigator. Dr. Farmer is a world expert in critical care education and the past president of the Society of Critical Care Medicine.  Great news for the CERTAIN team!

Please contact us with any questions regarding the disclosure.

Nursing Resouces

“I truly believe that nurses are essential members of the health care team – especially given their 24/7 presence at the bedside. However, the concept of “team” can have many different connotations! The American Association of Critical-Care Nurses (AACN) has proposed standards for a health work environment – you may be familiar with these? I have provided the link here for you to explore.

I mention this only because it is important to know how nurses are perceived as members of the health care team. For example, is interprofessional collaboration fully embraced by nurses, physicians, respiratory therapists, dieticians, etc.? Are all nurses expert communicators? If not, then implementing CERTAIN could be a challenge. I would encourage you to explore these issues with all members of the team. the AACN provides a free assessment tool for help with this.

I would also encourage you to be certain that the nurses are competent and confident in their critical care nursing skills. For example, do you have many novice (new) nurses on your unit? I believe that competence breeds confidence and one’s expertise must first be recognized as well as valued by the team for effective communication and collaboration about patient care to occur.

You might want to identify CERTAIN champions – key nurses who are respected for their knowledge and skills and especially interested in the CERTAIN project. These nurses (we call them “super-users” whenever we introduce new technology where I work) could serve as important resources for the staff.”

– Professor Linda Bucher, Implementation expert, CERTAIN team