Abstract P-034: CRITICAL DETERIORATION LEADING TO UNPLANNED ICU ADMISSION AND COMPLIANCE WITH THE CHAIN OF PREVENTION; A SYSTEMATIC REVIEW

Abstract

Aims & Objectives: Published literature on interventions to reduce critical deterioration in children have inconsistently reported compliance with the Chain of Prevention; Monitoring, Recognition, Escalation and Response. This makes it difficult to robustly evaluate the evidence of effectiveness. The aim of the systematic review was to identify the gaps in reporting so that recommendations could be made to strengthen the reporting of these safety initiatives. Methods A systematic review of the literature was conducted for years 2003–2017 and followed the search strategies developed by the Cochrane Collaboration which complied with Peer Review of Electronic Search Strategies (PRESS) guidance. The search criteria used PICO formatResults A total of 23 publications from 21 studies reported on components of the Chain of Prevention. The main focus of reporting was on the processes for recognition and escalation. Only one study addressed all the components, six reported on monitoring and two reported on response. Summary details of the recommendations for future reporting of critical deterioration are presented below.Conclusions Existing processes for reporting on initiatives aimed at reducing paediatric critical deterioration in hospital are not robust enough to provide assurance of compliance with the Chain of Prevention. Previous initiatives may have been judged as poorly performing when it is the underpinning organisational safety process, which has been deficient. There is an urgent need for standardisation and strengthening of reporting of studies, using a model similar to the STROBE and STARD initiatives. This will enable the development of a robust evidence base and international benchmarking.