Abstract O-54: PERFORMANCE OF ELECTRONIC DASHBOARD IN RECOGNITION OF CLINICAL DETERIORATION IN PEDIATRIC ACUTE CARE PATIENTS

Abstract

Aims & Objectives: Rapid response team (RRT) functionality requires two critical elements: early recognition of clinical decline and ability to intervene. Components of early recognition would ideally be both sensitive and specific, identifying a high proportion of declining patients, without overburdening the RRT. We evaluated the performance of an electronic system of organizing pediatric patients identified as high risk for clinical deterioration to facilitate surveillance. Methods Modified Pediatric Early Warning scoring (MPEWS) was performed every 4 hours within the electronic medical record. Four categories comprise patients identified as high risk and present on the electronic dashboard: 1) MPEWS score > 5 in first 24 hours of admission, 2) MPEWS > upper confidence interval from patient baseline after 24 hours, 3) previous RRT, and 4) staff concern. Results From 10-1-2015 to 6-30-17, 920 patients transferred from acute care to ICU and 795 (86%) were identified on the electronic dashboard > 1hour prior to transfer. Four types of alerts contributed to the dashboard: MPEWS < 24 hours 332 (42%), MPEWS > 24 hours 94 (12%), clinical concern 220 (28%) and previous RRT 149 (19%). Patient Rescue events (ICU intervention within 2 hours of transfer to the ICU) occurred in 101 patients. Of these, 86 (85%) were present on dashboard. Conclusions Our electronic system to organize surveillance correctly identifies most of the patients within 1 hour prior to the transfer. The occurrence of patient Rescue events, despite the ability to accurately identify the patients, suggests that the ability to quickly intervene is an area for improvement.