Implementation of a Communication Bundle for High-Risk Patients

Area of Science:

• Pediatric hospital medicine
• Patient safety research
• Healthcare quality improvement

Background:

• Early identification and management of deteriorating hospitalized pediatric patients reduce mortality.
• High-risk patients, termed "watchers," require enhanced monitoring and communication.
• Communication errors are a significant factor in unrecognized patient deterioration.

Purpose of the Study:

• To increase the implementation rate of a communication, teamwork, and planning bundle for eligible "watchers" within 2 hours of identification.
• To improve situation awareness for pediatric patients at high risk of deterioration.
• To achieve an 80% bundle completion rate from a baseline of 28%.

Main Methods:

• A multidisciplinary team educated stakeholders on a novel bundle for "watchers" on two hospital medicine units.
• Automated physician notifications and daily data analysis were used for real-time feedback and reminders.
• The intervention focused on contingency planning and clear communication expectations.

Main Results:

• The percentage of "watchers" with a complete situation awareness bundle within 2 hours increased from 28% to 81%.
• This improvement was sustained for over two years.
• No significant changes in rapid response team calls or ICU transfers were observed on intervention units, despite hospital-wide increases.

Conclusions:

• A novel bundle incorporating contingency planning and communication protocols effectively improved situation awareness for high-risk pediatric patients.
• Multidisciplinary engagement and the use of automated electronic health record technology were crucial for successful implementation and sustained adherence.
• The intervention demonstrates a successful strategy for reducing unrecognized deterioration in hospitalized children.