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. 2023 May 22;8(3):e645.
doi: 10.1097/pq9.0000000000000645. eCollection 2023 May-Jun.

Reduction of Very Rapid Emergency Transfers to the Pediatric Intensive Care Unit

Stacy E Kuehn  1 , Jennifer E Melvin  1 , Pamela S Creech  1 , Jill Fitch  1 , Garey Noritz  1 , Michael F Perry  1 , Claire Stewart  1 , Ryan S Bode  1
Affiliations

Reduction of Very Rapid Emergency Transfers to the Pediatric Intensive Care Unit

Stacy E Kuehn et al. Pediatr Qual Saf. .

Abstract

Introduction: Emergency transfers are associated with increased inpatient pediatric mortality. Therefore, interventions to improve system-level situational awareness were utilized to decrease a subset of emergency transfers that occurred within four hours of admission to an inpatient medical-surgical unit called very rapid emergency transfers (VRET). Specifically, we aimed to increase the days between VRET from non-ICU inpatient units from every 10 days to every 25 days over 1 year.

Methods: Using the Model for Improvement, we developed an interdisciplinary team to reduce VRET. The key drivers targeted were the admission process from the emergency department and ambulatory clinics, sepsis recognition and communication, and expansion of our situational awareness framework. Days between VRET defined the primary outcome metric for this improvement project.

Results: After six months of interventions, our baseline improved from a VRET every 10 days to every 79 days, followed by another shift to 177 days, which we sustained for 3 years peaking at 468 days between events.

Conclusion: Interventions targeting multiple admission sources to improve early recognition and communication of potential clinical deterioration effectively reduced and nearly eliminated VRET at our organization.

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Conflict of interest statement

The authors have no financial interest to declare in relation to the content of this article.

Figures

Fig. 1.
Fig. 1.
Key Driver diagram: increasing situational awareness: VRET reduction.
Fig. 2.
Fig. 2.
Statistical Process Control Chart: primary metric showing days between VRETs with the timeline of interventions.
Fig. 3.
Fig. 3.
Pareto charts showing contributing conditions to VRET.
Fig. 4.
Fig. 4.
Pareto charts showing admission source before VRET.
Fig. 5.
Fig. 5.
Statistical process control chart showing the percent of ACT events on the floor in less than 4 hours.
Fig. 6.
Fig. 6.
Statistical process control chart showing the percent of consultation team (ACT) events resulting in the transfer to the intensive care unit.
See this image and copyright information in PMC

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