(1385) Improving High-Risk Patient Identification and Preparedness

Introduction: Situational awareness (SA) has been showed to reduce cardiac arrests in the Pediatric Intensive Care Unit (PICU) by Dewan et al. SA includes the front-line provider, nurse, and respiratory therapist (RT) understanding why their patient is at high risk of cardiac arrest and potential mitigation plans. We adapted this work to our local context and established the need for high-risk patient signs in our PICU.

Methods: We examined our PICU codes that were longer than one minute from January to December 2022. Patients were only identified as high-risk once per day. We collected characteristics of these codes, such as whether a patient had been identified as high-risk patient. We then adapted a high-risk patient bedside sign using these patient characteristics. After the sign was developed, we surveyed nurses, charge nurses, RTs, and front-line providers (FLPs) in Fall 2023. We asked if their patient was high-risk, and if so, the reasons why, and the mitigation plan.

Results: Around a quarter of 2022 PICU codes (26%, 7/27) had been identified as high-risk for cardiac arrest. If we included those who arrested shortly after admission, those who coded within 24 hours, and those undergoing intubation from non-invasive ventilation around arrest time, this rose to 70% (19/27). Our high-risk patient bedside sign incorporated these aspects.

Of the 42 high-risk patient opportunities, we found that most nurses (97%, 31/32), RTs (84%, 21/25), charge nurses (100%, 20/20), and FLPs (93%, 14/15) knew their patient was high-risk. However, 8% of bedside nurses (4/49) and 22% of RTs (7/32) thought their patient was high-risk when they were not. On qualitative assessment, we found discrepancies. For one high-risk patient due to pulmonary hypertension, the RT identified the potential ETT cuff popping as the high-risk reason. CPR events remained stable at 2.5 events per 1000 patient days.

Conclusions: With our work, we were able to adapt a high-risk patient sign to our local context based on our previous code events. Furthermore, we established the need for high-risk patient bedside signs given that high-risk patients were only being identified once per day—missing a large cohort of patient at risk of cardiac arrest—and there was limited situational awareness of the reasons a patient was high-risk for cardiac arrest.