104. IDENTIFYING PATIENTS AT RISK OF CLINICAL DETERIORATION PRIOR TO PICU TRANSFER

Abstract

BackgroundCleveland Clinic Children's incorporated the Situational Awareness (SA) model in 2013 to prevent and reduce patient unrecognized clinical deterioration (UCD). The model equips healthcare providers to identify patients at risk of deterioration via use of various criteria and intervene in a timely manner. From April 2018 through August 2018, only 14% of patients transferred to the PICU from the RNF were identified as SA. Our goal was to increase utilization of the SA model to identify patients at risk of clinical deterioration to at least 50% prior to PICU transfer. This project was sponsored by an ACGME initiative aimed at supporting innovation to transform the clinical learning environment where residents pursue their training.Aim StatementIncrease the percentage of patients identified as Situational Awareness prior to transfer to PICU from 14% to 50% by November, 2018.InterventionsInterventions were implemented over a period of 4 months: 1) incorporating assessment of patients SA status during morning rounds with the multidisciplinary team including Nursing, 2) SA discussion during resident afternoon sign-out and 3) adding SA status identification box into the resident electronic sign-out form. The processes were audited randomly to ensure interventions were being carried out.MeasuresData were collected through a retrospective chart review surveying SA documentation of patients prior to PICU transfer from the RNF. Only patients under Pediatric resident-run services were included. Data were obtained from Cleveland Clinic Quality Data Registries and monitored bi-weekly.ResultsFollowing implementation of interventions, data show a median of 50% of patients being identified as SA prior to transfer to PICU. Based on observations and audits, those teams which included Nursing on morning rounds had better outcomes. Assessment of patients during morning rounds had the most profound impact whereas though resident sign-out interventions had a positive effect, they were not implemented to their full extent as seen on audit checks and required multiple education sessions. Conclusions and Next Steps Interventions were successful at increasing the utilization of the SA model. As noted by consecutive points above baseline median, this shift in the data signals a non-random pattern. We hope, adherence to SA model, can prevent UCD. There is still room for improvement and future interventions will focus on sustainability and use of technology to hardwire the process and promote adherence to routinely assessment of SA status. Cleveland Clinic Children's incorporated the Situational Awareness (SA) model in 2013 to prevent and reduce patient unrecognized clinical deterioration (UCD). The model equips healthcare providers to identify patients at risk of deterioration via use of various criteria and intervene in a timely manner. From April 2018 through August 2018, only 14% of patients transferred to the PICU from the RNF were identified as SA. Our goal was to increase utilization of the SA model to identify patients at risk of clinical deterioration to at least 50% prior to PICU transfer. This project was sponsored by an ACGME initiative aimed at supporting innovation to transform the clinical learning environment where residents pursue their training. Increase the percentage of patients identified as Situational Awareness prior to transfer to PICU from 14% to 50% by November, 2018. Interventions were implemented over a period of 4 months: 1) incorporating assessment of patients SA status during morning rounds with the multidisciplinary team including Nursing, 2) SA discussion during resident afternoon sign-out and 3) adding SA status identification box into the resident electronic sign-out form. The processes were audited randomly to ensure interventions were being carried out. Data were collected through a retrospective chart review surveying SA documentation of patients prior to PICU transfer from the RNF. Only patients under Pediatric resident-run services were included. Data were obtained from Cleveland Clinic Quality Data Registries and monitored bi-weekly. Following implementation of interventions, data show a median of 50% of patients being identified as SA prior to transfer to PICU. Based on observations and audits, those teams which included Nursing on morning rounds had better outcomes. Assessment of patients during morning rounds had the most profound impact whereas though resident sign-out interventions had a positive effect, they were not implemented to their full extent as seen on audit checks and required multiple education sessions. Conclusions and Next Steps Interventions were successful at increasing the utilization of the SA model. As noted by consecutive points above baseline median, this shift in the data signals a non-random pattern. We hope, adherence to SA model, can prevent UCD. There is still room for improvement and future interventions will focus on sustainability and use of technology to hardwire the process and promote adherence to routinely assessment of SA status.