Reducing Hospital-Acquired Conditions in the Pediatric Intensive Care Unit With a High-Risk Rounding Process

Required reading for all learners: Implicit Bias impacts patient outcomes

Preventing hospital-acquired conditions is paramount to patient safety. Critically ill children are highly susceptible to hospital-acquired harm. To prevent hospital-acquired conditions, the pediatric intensive care unit at a quaternary care center implemented a novel multidisciplinary high-risk rounding program to improve unit work culture and address increased hospital-acquired condition rates before and during the COVID-19 pandemic. Patients at greatest risk for selected hospital-acquired conditions were identified for the high-risk rounding program. This program offered rounds with scripted questions about elements of hospital-acquired conditions followed by education and/or acquisition of needed resources. Primary quality improvement outcomes were overall preimplementation and postimplementation rates of the following hospital-acquired conditions: central line [catheter]–associated bloodstream infection, catheter-associated urinary tract infection, unplanned extubation, and pressure injury. Sustainability of the project was also evaluated. Over 2 years, 624 rounds for 488 unique patients were conducted. Rounds resulted in 351 interventions, including escalation of concerns, direct patient care, resource procurement, and education. Patients who received high-risk rounds were less likely than those who did not receive rounds to incur a hospital-acquired condition. The mean rate of study hospital-acquired conditions decreased from 5.41 to 2.89 events per 1000 patient days following detection of special cause variation. High-risk rounds prevented an estimated 50 hospital-acquired conditions during the study period. Implementation of high-risk rounds reduced the rate of study-specific hospital-acquired conditions by 46.5% and was sustainable over the 2-year study period.