O3011: Improving the Quality of Resuscitations in the Pediatric Critical Care Unit Using Video Recordings

Purpose/Objectives: 2021 SOCC Project Grant:
Patient outcomes following cardiac and respiratory arrest are optimized when team communication, leadership and technical skills are at peak performance. The use of video recordings to assess and improve the quality of resuscitation efforts has been demonstrated to be an effective tool for team feedback for neonates immediately following delivery and for trauma patients in the Emergency Department. SSM Health Cardinal Glennon Children’s Hospital (CGCH) has implemented structured video reviews in the neonatal delivery rooms and the emergency department (ED) as part of a resuscitation program quality improvement initiative. We have expanded this process to the CGCH pediatric intensive care unit (PICU). With the addition of six cameras, we have began recording all cardiac resuscitation events that occur in the PICU. We expect this project will result in identification of previously unrecognized systemic problems and demonstrate improvement in the quality of resuscitation care specific to the PICU environment.

Design/Methods: Six video cameras were mounted on the wall in six PICU rooms. Upon activation of the emergency alert, the team arrives to the patient’s bedside. The charge nurse will push the power button to turn the camera on and start recording the event. Following the event, the SD card and battery will be removed from the camera, the video will be saved to an external hard drive and placed in a secure location. The video is erased from the SD card and placed back in the camera. Within one week, the video will be reviewed by the PICU event review team. The results of this video review will be compared to the hot debrief by a specialist to identify missed opportunities, inaccuracies, discrepancies, and any added information as a way of assessing portable video capabilities as a tool in the PICU.

Results: A total of 4 resuscitations were recorded in the 4 months since the study began. All 4 of these events were cardiac arrest requring compressions. One event progressed to ECPR. 3 of the 4 events were less than 5 minutes. The patient monitor was unable to be clearly visualized in the first 4 events requring this data to be obtained from the documented data.

Conclusion/Discussion: We have shown the ability to use video recordings in PICU to capture events. There have been challenges with the cameras such as, difficulty seeing the monitor clearly, inability to capture the first few minutes of the event, and missing events that occur in other rooms. We have evaluated these events for subjective data such as team leadership and medical management. We plan to have the video reviews compared to the hot debrief by a quality specialist. More data is needed to evaluate the specifics of each event for a more thorough review.