Reduction of Very Rapid Emergency Transfers to the Pediatric Intensive Care Unit

Area of Science:

• Pediatric hospital medicine
• Quality improvement science
• Patient safety

Background:

• Emergency transfers are linked to higher pediatric inpatient mortality.
• Very rapid emergency transfers (VRET) within four hours of admission to medical-surgical units represent a critical safety concern.
• Improving system-level situational awareness is crucial for patient safety.

Purpose of the Study:

• To decrease very rapid emergency transfers (VRET) in pediatric patients.
• To increase the interval between VRET events from every 10 days to every 25 days within one year.
• To enhance early recognition and communication of clinical deterioration.

Main Methods:

• Utilized the Model for Improvement framework.
• Established an interdisciplinary team to target key drivers of VRET.
• Focused on improving the admission process, sepsis recognition, communication, and situational awareness.

Main Results:

• Achieved a sustained reduction in VRET, improving from a baseline of every 10 days to every 79 days within six months.
• Further improved the interval to 177 days, eventually peaking at 468 days between VRET events.
• Demonstrated sustained improvement over three years.

Conclusions:

• Targeting multiple admission sources and enhancing early recognition and communication effectively reduced VRET.
• Interventions significantly improved patient safety by nearly eliminating VRET.
• System-level improvements in situational awareness are vital for reducing adverse events in pediatric care.