Improving Situational Awareness to Decrease Emergency ICU Transfers for Hospitalized Pediatric Cardiology Patients.

Area of Science:

• Pediatric Cardiology
• Quality Improvement Science
• Patient Safety

Background:

• Critical patient deterioration is a major cause of preventable harm in hospitalized pediatric cardiac patients.
• Emergency transfers (ETs) and code events outside the ICU are frequent and associated with adverse outcomes.
• The acute care cardiology unit (ACCU) aimed to reduce these events.

Purpose of the Study:

• To increase the number of days between emergency transfers (ETs) and code events on an ACCU.
• To improve patient safety by mitigating critical patient deterioration.
• To achieve a target of at least 70 days between ETs and 90 days between code events within 12 months.

Main Methods:

• Utilized the Institution for Healthcare Improvement model.
• Implemented interventions focused on enhancing situational awareness (SA), including a 'Must Call List,' evening rounds, a visual management board, and daily huddles.
• Employed statistical process control charts to analyze outcome and process measures.

Main Results:

• Achieved a sustained increase in the median days between ETs from 17 to 56 days and between code events from 32 to 62 days.
• Intervention utilization rates were high, ranging from 87% to 100%.
• No adverse impact was observed on the balancing measure of cardiac ICU length of stay.

Conclusions:

• Interventions designed to improve situational awareness in vulnerable pediatric cardiac patients led to sustained reductions in ETs and code events outside the ICU.
• The quality improvement project successfully enhanced patient safety on the ACCU.
• Focusing on SA is crucial for preventing critical events in high-risk pediatric populations.