(1263) Promoting PICU Resilience With Multidisciplinary Quality Assurance and Performance Improvement

Introduction: Utilizing institutional data for quality improvement has become a necessary tool for identifying and promoting highly reliable patient centered care. We added a single site multidisciplinary model to our existing multi-site PICU QAPI that is grounded in a resilience framework. Our multi-site model endorses empowered execution of learn-respond- monitor- anticipate frameworks to quickly develop and implement change. We hypothesized that applying this resiliency framework with a multidisciplinary approach at the singular unit level will rapidly improve our team’s ability to accomplish quality innovation and execution of data driven improvement.

Methods: A multidisciplinary team (physicians, advanced practice providers, nurses, respiratory therapists, quality, and administrative) reviewed 6 activity variables, 8 acuity variables, and 16 patient centered outcomes using real time data acquisition from five sources monthly. Data pre- and post-intervention were compared using student’s t-test. We reviewed safety events with practice changes and prepared for policy and procedure updates in health care delivery. New quality initiatives were refined and exemplary efforts in quality improvement were recognized.

Results: Comprehensive, multidisciplinary data monitoring occurred over the course of two years embedded within a multisite model and for three months with a local multidisciplinary team and is ongoing. Debriefing occurred following a 48-hour internet outage arising from a hurricane. Adaptations for new policies and procedures included the introduction of new endotracheal tube securement tape in response to increased unplanned extubation rates [0 to 1.21] in a 6-month period. Anticipatory responses included preparedness to manage an increased number of rapid response calls following rapid response education on the acute care floor. Examples of quality improvement innovation includes 1) optimizing the timing of routine radiology studies for prevention of ICU delirium and 2) decreasing time from order to administration of antibiotics for sepsis.

Conclusions: A multidisciplinary, data driven approach to quality assurance and performance improvement rapidly promotes PICU resiliency and fosters innovation in quality improvement.