Reducing Hospital-Acquired Conditions in the Pediatric Intensive Care Unit With a High-Risk Rounding Process.

Area of Science:

• Pediatric Intensive Care
• Quality Improvement Science
• Patient Safety

Background:

• Hospital-acquired conditions (HACs) pose a significant risk to critically ill children.
• Preventing HACs is a critical component of patient safety in pediatric intensive care units (PICUs).
• The COVID-19 pandemic exacerbated challenges in preventing HACs.

Purpose of the Study:

• To implement and evaluate a novel interprofessional high-risk rounding program in a PICU.
• To reduce the incidence of specific hospital-acquired conditions.
• To improve the unit work culture and address increased HAC rates.

Main Methods:

• A high-risk rounding program was implemented, targeting patients most susceptible to HACs.
• Rounds included scripted questions, followed by targeted education and resource acquisition.
• Quality improvement outcomes measured were rates of central line-associated bloodstream infections, catheter-associated urinary tract infections, unplanned extubations, and pressure injuries.

Main Results:

• 624 rounds were conducted for 488 patients over two years, leading to 351 interventions.
• Patients receiving high-risk rounds had a significantly lower likelihood of incurring a HAC (χ2 = 22.5, P < .001).
• The rate of project-specific HACs decreased by 46.5%, from 5.41 to 2.89 events per 1000 patient days, preventing an estimated 50 HACs.

Conclusions:

• The interprofessional high-risk rounding program effectively reduced hospital-acquired conditions in a PICU.
• The observed reduction in HACs was sustained over the two-year project duration.
• This initiative highlights the success of proactive, interprofessional rounds in enhancing patient safety.