Abstract P-448

Abstract

Aims & Objectives: Cardiac arrests in PICU are infrequent but can cause significant mortality & morbidity, prolonging stay and increasing healthcare expenses. Between July 2015 and 2016, 7.2% of admissions to our unit had a cardiac arrest, which is much higher in comparison with multi-centre studies (2–3%). We designed a QI project aiming to reduce the number of cardiac arrests on LCH PICU by 50%, with a multi-dimensional approach. Methods We involved front line teams, reviewed recent cases of cardiac arrests and conducted a safety climate survey to identify areas for improvement. ReCAP initiative uses quality improvement methodology to actively identify high risk patients, address gaps in knowledge, provide clarity in communication and encourage a learning and supportive culture. The five main dimensions are recognition, pre-brief, clear documentation, debrief and simulation aimed to improve situational awareness and human factors related to escalation and early intervention. Pre-brief is the heart of this project, a novel concept adapted from aviation. A senior clinician leads a group discussion about pathology, signs of deterioration, immediate plan and role allocation for possible resuscitation for any child deemed to be at risk of cardiac arrest. Results Since launching on 1st January 2017, we have seen a 46% reduction in cardiac arrests compared to the last 2 years. There has been a tangible improvement in situational awareness and safety culture as evident by regular feedback. Conclusions Innovative strategies like pre-brief and addressing human factors with input from front-line teams can improve quality of care and patient safety.