1 Driving team-based critical thinking using an emergency department (ED) pediatric assessment tool. (25th November 2019)

• Record Type: Journal Article
• Authors: Martinez, Elizabeth; Sepanski, Robert; Jennings, A Dawn; Schmidt, James; Godambe, Sandip
• Is Part Of: BMJ open quality. Volume 8:Supplement 2(2019)
• Page Start: A1
• Page End: A3
• Publication Date: 2019-11-25
• Subjects: Medical care -- Quality control -- Periodicals; 362.106805
• DOI: 10.1136/bmjoq-2019-ihi.1
• Languages: English
• ISSNs: 2399-6641

Abstract

Abstract : Background: Missing signs of sepsis can result in delayed diagnosis, treatment and complications. We have introduced an ED-based Children At High Risk(CAHR-AT) tool to improve recognition, team critical thinking, and patient outcomes. Delayed recognition and poor nurse-provider communication were identified as common challenges in timely treatment of children at high-risk for infection-related decompensation. Objectives: This stand-alone urban children's hospital ED aims to improve team-based care, situational awareness, and patient outcomes through team huddles and associated interventions (figure 1 ). Methods: Development of the CAHR-AT utilized vital signs data of >1 × 10^6 patients to derive standards. Logistic regression and 'machine-learning(AI)' identified factors showing the highest association with gold-standard sepsis cases and applied weights to each factor for optimum sensitivity. A nursing assessment form was added to the dyad assessment process and visual redesign of the tool interface went into effect using a stoplight approach with red, yellow, and green lights indicating patient acuity and resources needed (figure 2 ). Results: It has been over 239 days (934 alerts) since the last unanswered alert by the provider/nurse dyad (figure 3 ). The average percent of CAHR patients with a completed initial huddle increased from 9.3% to 45.3% (figure 4 ). Higher CAHR-AT scores were associated with higher severity-of-index (SOI) and acute kidney injury (AKI) within 48 hrs of arrival (figures 5 and 6 ). Preliminary data show CAHR-AT patients with a score ≥8 who received the bundle (IV-fluid bolus and IV-antibiotics) significantly shorter length of stays (figure 7 ). Conclusions: CAHR-AT predicts physiologic decompensation and AKI. Its processes promote team-based critical thinking and improve patient outcomes. Next steps include prescriptive order sets for both red/yellow stoplight activations and spread to inpatient units.