Presentation
HE15 - Proactive Safety: Implementing a Novel Rounding Approach to Reduce Hospital Acquired Conditions in the PICU
SessionPoster Session 1
DescriptionThe Human Factors community has increasingly focused on proactive safety, or Safety-II. In this view, we focus on learning from successes and preventing risky situations. In this specific example, we are trying to enhance resilient practices of frontline team members as they care for critically ill patients and proactively ensure they have the resources and support they need.
Critically ill children are at unique risk for the development of hospital-acquired conditions (HACs). Evidence-based guidelines and HAC bundles exist, but HAC prevention remains a challenge especially in the recent strain of nursing turnover and high patient volumes. We implemented a novel multidisciplinary high-risk rounding (HRR) program that 1) identified pediatric intensive care unit (PICU) patients at greatest risk for development of multiple HACs and 2) provided prompt education and resources to promote patient safety and communication. Our study aimed to evaluate if HRR was effective in prevention of the following HACs: Central line-associated blood stream infection, catheter associated urinary tract infection, unplanned extubation and pressure injury. Considering human factors approaches when designing interventions was helpful in this case to go beyond traditional education approaches towards a multi-pronged discussion to prompt and promote in-the-moment resources.
This pilot study was performed from March 1, 2022 to June 1, 2023 in our 48 bed PICU. High-risk (HR) was defined as any of the following: ECMO or CRRT requirement (n=75), intubated status (n=300), continuous EEG use (n=33), and Braden Q score < 16 (n=178). A team of 2 individuals (a nurse champion and another multidisciplinary team member) rounded weekly on identified patients by introducing the project to the bedside nurse and performing a “touch base” on HAC elements recorded in a REDCap survey. Our primary outcome was HAC rates pre-and post-implementation. This process did not serve as HAC audits.
There were 360 rounds of HRR conducted with 291 unique patients. Rounding resulted in 294 interventions, including escalation of concerns, direct patient care, resource procurement, and education. The mean time spent per patient was 4.75 minutes (SD=3.78). Patients who underwent HRR were less likely to have HACs; a chi-squared analysis revealed a negative association between receiving HRR and HACs, χ2(1)= 22.5, p= < 0.001. Compared to the year prior to HRR, the mean rate of overall HACs per 1,000 patient days decreased from 6.42 (SD=3.9) to 3.66 (SD=1.7).
Implementation of HRR successfully decreased PICU HACs by an estimated 30 events, equating to potentially $500,000 to $3 million dollars in cost savings. Team member perceptions of HRR were overwhelmingly positive. Future directions of this innovative approach include studying the impact of HRR on unit psychological safety.
Critically ill children are at unique risk for the development of hospital-acquired conditions (HACs). Evidence-based guidelines and HAC bundles exist, but HAC prevention remains a challenge especially in the recent strain of nursing turnover and high patient volumes. We implemented a novel multidisciplinary high-risk rounding (HRR) program that 1) identified pediatric intensive care unit (PICU) patients at greatest risk for development of multiple HACs and 2) provided prompt education and resources to promote patient safety and communication. Our study aimed to evaluate if HRR was effective in prevention of the following HACs: Central line-associated blood stream infection, catheter associated urinary tract infection, unplanned extubation and pressure injury. Considering human factors approaches when designing interventions was helpful in this case to go beyond traditional education approaches towards a multi-pronged discussion to prompt and promote in-the-moment resources.
This pilot study was performed from March 1, 2022 to June 1, 2023 in our 48 bed PICU. High-risk (HR) was defined as any of the following: ECMO or CRRT requirement (n=75), intubated status (n=300), continuous EEG use (n=33), and Braden Q score < 16 (n=178). A team of 2 individuals (a nurse champion and another multidisciplinary team member) rounded weekly on identified patients by introducing the project to the bedside nurse and performing a “touch base” on HAC elements recorded in a REDCap survey. Our primary outcome was HAC rates pre-and post-implementation. This process did not serve as HAC audits.
There were 360 rounds of HRR conducted with 291 unique patients. Rounding resulted in 294 interventions, including escalation of concerns, direct patient care, resource procurement, and education. The mean time spent per patient was 4.75 minutes (SD=3.78). Patients who underwent HRR were less likely to have HACs; a chi-squared analysis revealed a negative association between receiving HRR and HACs, χ2(1)= 22.5, p= < 0.001. Compared to the year prior to HRR, the mean rate of overall HACs per 1,000 patient days decreased from 6.42 (SD=3.9) to 3.66 (SD=1.7).
Implementation of HRR successfully decreased PICU HACs by an estimated 30 events, equating to potentially $500,000 to $3 million dollars in cost savings. Team member perceptions of HRR were overwhelmingly positive. Future directions of this innovative approach include studying the impact of HRR on unit psychological safety.
Event Type
Poster Presentation
TimeMonday, March 314:45pm - 6:15pm EDT
LocationFrontenac Foyer
Digital Health (DH)
Simulation and Education (SE)
Hospital Environments (HE)
Medical and Drug Delivery Devices (MDD)
Patient Safety and Research Initiatives (PS)