Pediatric Cardiac Critical Care Fellow Arkansas Children's Hospital North Little Rock, Arkansas, United States
Abstract:
Introduction: Given the high complexity of the patient population Cardiac arrest remains a significant risk for patients in pediatric cardiac intensive care (CICU). To reduce cardiac arrest rates in our CICU patient population, we initiated a multidisciplinary quality improvement project and later expanded this initiative through the Pediatric Cardiac Critical Care Consortium Cardiac Arrest Prevention (CAP) bundle. The objective of the project was to reduce cardiac arrest rates in our CICU.
Methods: This quality improvement initiative analyzed cardiac arrest events in our single center over a 10-year period in our 30-bed pediatric CICU. Phase one of the QI project was aimed at identifying and analyzing staff baseline practices, the technical and behavioral aspects of resuscitation. Deficits within each event were categorized by performance, communication, documentation, or system/ process issues and then mitigation strategies were implanted. Phase Two was focused on prevention: patients were identified as high risk for arrest and specific arrest prevention measures were implemented for those patients. The statistic used to analyze the data throughout is % change in the rate of cardiac arrest incidence over time. Improvements included a standardized debriefing following each code event (2009), which allowed for the identification of opportunities within the event and the implementation of mitigation strategies as appropriate. A variety of behavioral strategies were adopted; communication methods were enhanced (e.g. introduction of standardized hand-off process, code notification, and batch paging) and guidelines for escalation of care were developed and streamlined. A longitudinal review of human factors helped to create an awareness of its play in crisis situations; use of high-fidelity simulation for resuscitation training helped to boost team confidence and comfort with emergency situations. Tools were developed to enhance situational awareness of high acuity care conditions for frontline staff and of emergency preparedness planning to handle the crisis. In 2018, our unit participation in the multicenter PC4 CAP bundle effort allowed us to further refine our intra-organizational prevention efforts. At the conclusion of the collaborative, many of the prevention bundle components were adopted and incorporated into our arrest prevention strategy.
Results: Cardiac arrest incidence declined in both Phase one and Phase two of improvement efforts. Incidence per 1000 patient days decreased in Phase One from 3.5% in 2009 to 1.8% in 2017. In Phase Two beginning in 2018, the rates decreased further to a low of 0.6% in 2021. Conclusions A reduction in cardiac arrest rates in our CICU is shown through the sequential implementation of specific multifaceted interventions with dynamic standardization embedded in everyday practice. This reduction was sustained over a 10-year period.
