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. 2017 Sep;7(9):523-529.
doi: 10.1542/hpeds.2016-0170.

Implementation of a Communication Bundle for High-Risk Patients

Michelle W Parker  1 , Matthew Carroll  2 , Benjamin Bolser  3 , Janelle Ballinger  4 , John Brewington  5 , Suzanne Campanella  6 , Andrew Davis-Sandfoss  7 , Karen Tucker  4 , Patrick W Brady  3   8
Affiliations

Implementation of a Communication Bundle for High-Risk Patients

Michelle W Parker et al. Hosp Pediatr. 2017 Sep.

Abstract

Background: Interventions that facilitate early identification and management of hospitalized pediatric patients who are at risk for deterioration are associated with decreased mortality. In our large pediatric hospital with a history of success in decreasing unrecognized deterioration, patients at higher risk of deterioration are termed "watchers." Because communication errors often contribute to unrecognized deterioration, clear and timely communication of watcher status to all team members and contingency planning was desired.

Objectives: Increase the percentage of eligible watchers with a complete communication, teamwork, and planning bundle within 2 hours of identification from 28% to 80%.

Methods: Watchers admitted to Hospital Medicine on 2 targeted units were eligible. Stakeholders were educated to facilitate ownership. Daily data analysis enabled real-time failure identification. Automated physician notification provided reminders for timely communication.

Results: The percentage of watchers with a complete situation awareness bundle within 2 hours increased from 28% to 81% and was sustained for more than 2 years. There was no change in rates of rapid response team calls or ICU transfers on our intervention units, but these both increased throughout the hospital. Education facilitated modest improvement, with marked improvements and sustainment through use of technology.

Conclusions: A novel bundle that included contingency planning and communication expectations was created to improve situation awareness for watchers. Multidisciplinary engagement and use of automated technology facilitated by an electronic health record helped implement and sustain bundle adherence.

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Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
SA bundle key driver diagram.
FIGURE 2
FIGURE 2
Structured physician SA concern note template. PEWS, Pediatric Early Warning System.
FIGURE 3
FIGURE 3
Run chart of adherence to the complete SA bundle within 2 hours of watcher designation over time. Performance on 2 target HM units is combined. Solid boxes denote time points of implemented interventions, whereas dashed boxes denote interventions that were discontinued. RN, registered nurse.
FIGURE 4
FIGURE 4
Combined rates of RRT calls and ICU transfers per 10 000 patient days over time for the 2 HM intervention units.
FIGURE 5
FIGURE 5
Hospital -wide rates of RRT calls and ICU transfers per 10 000 patient days over time. Data reflect all inpatient units in aggregate.
See this image and copyright information in PMC

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References

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