(1384) Implementation of a Standardized Presentation Format for PICU Rounds: A Quality Improvement Project

Introduction: Rounds is an essential part of patient care in the pediatric intensive care unit (PICU). The residents on teaching teams at our quaternary academic children’s center are responsible for presenting patients on rounds. Prior to initiation of this project, there was no standard format for presenting information leading to disorganized patient presentations and inefficient rounds. The aim of this rounding reform quality improvement (QI) project is to increase adherence to a standardized rounding template to 80% from baseline.

Methods: We adopted a modified Subjective, Objective, Assessment, and Plan (SOAP) format as the standard for patient presentations. We collected baseline data regarding the inclusion of eight aspects of a standardized rounding template and time spent per patient and subsequently conducted three plan-do-study-act (PDSA) cycles: 1) targeted messaging with instructions to use SOAP format, 2) introduction of rounding sheets, and 3) in-person orientation to rounding at the start of each rotation. A member of the study team observed rounds multiple times per PDSA cycle. Student’s t-test was used to compare time per patient at baseline vs. post-intervention.

Results: Baseline data of 43 presentations demonstrated 40 (93%) contained overnight events, 30 (70%) contained patient one-liners, 34 (79%) contained imaging and laboratory data, 20 (46%) contained vital signs, 15 (34%) contained physical exam, 11 (25%) contained an assessment, 0 were in the correct order, and 15 (34%) separated hematology and ID into separate systems. The mean time per patient was 8.75 minutes. At the completion of the third PDSA cycle in July 2024, of 44 presentations, 100% contained subjective/overnight events, 43 (97%) contained one-liner, vitals, and separate hematology/ID, 42 (95%) were in the correct order, 40 (91%) contained an assessment, and 12(27%) contained physical exam. Mean time was 9.9 minutes (p=0.2).

Conclusions: This institutional QI project resulted in increased adherence to a standardized presentation format for PICU rounds with more than 90% adherence to seven out of eight targeted elements without an increase in time per patient. Next steps are to focus on bedside nurse and respiratory therapist involvement.