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Late Rescue Collaborative: Reducing Non-ICU Arrests
Nathan P Dean1, Emanuel Ghebremariam2, Rosemary Szeles3
1Division of Critical Care Medicine, Children's National Health System, Washington, DC.
Insights
Implementing a collaborative approach significantly reduced non-intensive care unit (ICU) arrests. This patient safety initiative improved outcomes by enhancing early recognition of patient deterioration.
Area of Science:
- Pediatric critical care
- Quality improvement science
- Patient safety research
Background:
- Non-intensive care unit (ICU) arrests pose a significant risk to patient safety.
- Effective early recognition and intervention are crucial for preventing adverse events in acute care settings.
Purpose of the Study:
- To decrease the incidence of non-ICU arrests.
- To implement and evaluate an intramural collaborative focused on identifying and managing patient deterioration.
Main Methods:
- A prospective quality improvement project was conducted at a tertiary children's hospital.
- The Late Rescue Collaborative, a multidisciplinary team, monitored escalation protocols and patient deterioration through regular meetings.
- Interventions were developed and implemented based on identified trends and lessons learned.
Main Results:
- Non-ICU arrest rates decreased from 0.31 to 0.11 per 1,000 patient days, sustained for 36 months.
- The average time between non-ICU arrests increased from 15.5 days to 61.5 days, sustained for 37 months.
- Mortality following non-ICU arrests dropped to zero between 2016 and 2018.
Conclusions:
- The Late Rescue Collaborative effectively reduced non-ICU arrests.
- This multidisciplinary approach is a valuable tool for enhancing patient safety and preventing critical events.
Objective:
To reduce the frequency of non-ICU arrests through the implementation of an intramural collaborative focused on patient deterioration.
Design:
Prospective quality improvement project.
Setting:
Single-center, free-standing, tertiary children's hospital.
Patients:
All patients admitted to acute care units.
Interventions:
The Late Rescue Collaborative was formed in 2014 to monitor compliance with hospital escalation protocols and evaluate episodes of patient deterioration. The collaborative is a multidisciplinary team of physicians, nurses, and respiratory care providers. Three monthly meetings occur: 1) individual acute care unit-based meetings to evaluate trends and performance; 2) hospital-wide multidisciplinary whole group meetings to review hospital trends in deterioration and share lessons learned; and 3) steering committee to determine areas of focus. Based on these three meetings, unit- and hospital-based interventions have been put in place to improve recognition of deterioration and promote early rescue.
Measurements And Main Results:
Rates of rapid response team activations, unplanned transfers, and non-ICU arrest are reported. Non-ICU arrest rates fell from a baseline of 0.31 per 1,000 non-ICU patient days to a new centerline of 0.11 and sustained for 36 months. Days between non-ICU arrests increased from a baseline of 15.5 days in year 2014 to a new centerline of 61.5 days and sustained for 37 months. Mortality following non-ICU arrests fell from four in 2014 and 2015 to zero in years 2016-2018.
Conclusion:
The Late Rescue Collaborative is an effective tool to improve patient safety by reducing non-ICU arrests.
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