Shifting the Paradigm: A Quality Improvement Approach to Proactive Cardiac Arrest Reduction in the Pediatric Cardiac Intensive Care Unit

Authors

Christine M. Riley, Children's National Hospital, Division of Cardiac Critical Care Medicine, Washington, D.C.
J Wesley Diddle, Children's National Hospital, Division of Cardiac Critical Care Medicine, Washington, D.C.
Ashleigh Harlow, Division of Nursing, Children's National Hospital, Cardiac Intensive Care Unit, Washington, D.C.
Kara Klem, Cardiac Acute and Critical Care, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pa.
Jason Patregnani, Division of Pediatric Critical Care, Barbara Bush Children's Hospital at Maine Medical Center, Portland, Maine.
Evan Hochberg, Business Process Consultant, University of Maryland-College Park, College Park, Md.
Jenhao Jacob Cheng, Division of Quality and Patient Safety, Children's National Hospital, Washington, D.C.
Sopnil Bhattarai, Division of Safety and Performance Improvement, Children's National Hospital, Washington, D.C.
Lisa Hom, Heart Center, Children's National Hospital, Washington, D.C.
Justine M. Fortkiewicz, Division of Nursing, Children's National Hospital, Cardiac Intensive Care Unit, Washington, D.C.
Darren Klugman, Division of Anesthesia Critical Care Medicine, Johns Hopkins Children's Center.

Document Type

Article

Publication Date

1-21-2022

Institution/Department

Pediatrics

Journal Title

Pediatric quality & safety

Abstract

INTRODUCTION: Children with cardiac conditions are at higher risk of in-hospital pediatric cardiopulmonary arrest (CA), resulting in significant morbidity and mortality. Despite the elevated risk, proactive cardiac arrest prevention programs in the cardiac intensive care unit (CICU) remain underdeveloped. Our team developed a multidisciplinary program centered on developing a quality improvement (QI) bundle for patients at high risk of CA. METHODS: This project occurred in a 26-bed pediatric CICU of a tertiary care children's hospital. Statistical process control methodology tracked changes in CA rates over time. The global aim was to reduce CICU mortality; the smart aim was to reduce the CA rate by 50% over 12 months. Interprofessional development and implementation of a QI bundle included visual cues to identify high-risk patients, risk mitigation strategies, a new rounding paradigm, and defined escalation algorithms. Additionally, weekly event and long-term data reviews, arrest debriefs, and weekly unit-wide dissemination of key findings supported a culture change. RESULTS: After bundle implementation, CA rates decreased by 68% compared to baseline and 45% from the historical baseline. Major complications decreased from 17.1% to 12.6% ( < 0.001) and mortality decreased from 5.7% to 5.0% ( = 0.048). These results were sustained for 30 months. CONCLUSIONS: Cardiac arrest is a modifiable, rather than inevitable, metric in the CICU. Reduction is achievable through the interprofessional implementation of bundled interventions targeting proactive CA prevention. Once incorporated into widespread efforts to engage multidisciplinary CICU stakeholders, these patient-focused interventions resulted in sustained improvement.

First Page

e525

Recommended Citation

Riley CM, Diddle JW, Harlow A, et al. Shifting the Paradigm: A Quality Improvement Approach to Proactive Cardiac Arrest Reduction in the Pediatric Cardiac Intensive Care Unit. Pediatr Qual Saf. 2022;7(1):e525. Published 2022 Jan 21. doi:10.1097/pq9.0000000000000525