(Screen 1 - 6:15 PM Friday) Tele-CICU command center model: Increasing patient safety with preventive virtual interventions in children with critical heart disease.

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Abstract: Introduction
Despite significant advances in surgical and medical treatment of children with critical heart disease, adverse events (AE) impacting survival and quality of life are still common in the CICU. Between Jan 2019 to December 2021, we developed a Tele-CICU command center model (TCC) to provide additional virtual collaboration & support to bedside teams (BT), focused on early detection of abnormal trends, targeted communications, and avoidance of AE. Stepwise interventions were implemented from our TCC: We developed workflows for Virtual surveillance (VS), targeted communications with BT and tele-CICU nurses; a cardiologist and neurologist were integrated, and review of adverse events was implemented. VS workflows included a review of remote monitoring, video feed from patient room cameras, medical records, and artificial intelligence tools. In case of discrepancy, BT maintained final say on approach. We present here our experience with critical communications (CC) with BT related with concerning trends and outcomes of these virtual interventions.
Methods
Retrospective, descriptive review of CC to bedside teams in electronic TCC database and electronic medical records (EMR) of CICU patients between January 2019 to December 2021. Communications were classified in 15 categories, and responses from bedside teams with related outcomes during the following 24 hrs. were verified.
Results
We found 159 CC (total TCC activities =12,138). Responses from bedside teams were 72.5% in agreement, 4.3% partial agreement and in 2.5% a different approach was elected. In 20.5 % there was no documented response. Among a sample of 122 CC with partial or total agreement, virtual interventions resulted in adjustment of medical treatment (75) or respiratory support (26), early resuscitation (4), surgery or intervention (15), or subspecialty consult (2).
Conclusions
Critical communications from a TCC in support of busy bedside teams resulted in early interventions by bedside teams and may have contributed to avoiding or mitigate adverse events. Further work is needed to establish whether these interventions contributed to improving patients’ outcomes.