(687) Preventing Hospital-Associated Conditions Through a Multidisciplinary High-Risk Rounding Program

Introduction: Critically ill children are at unique risk for the development of hospital-acquired conditions (HACs). Evidence-based guidelines and HAC bundles exist, but HAC prevention remains a challenge especially in the recent strain of nursing turnover and high patient volumes. We implemented an novel multidisciplinary high-risk rounding (HRR) program that 1) identified pediatric intensive care unit (PICU) patients at greatest risk for development of multiple HACs and 2) provided prompt education and resources to promote patient safety and communication. Our study aimed to evaluate if HRR was effective in prevention of the following HACs: Central line-associated blood stream infection, catheter associated urinary tract infection, unplanned extubation and pressure injury.

Methods: This pilot study was performed from March 1, 2022 to June 1, 2023 in our 48 bed PICU. High-risk (HR) was defined as any of the following: ECMO or CRRT requirement (n=75), intubated status (n=300), continuous EEG use (n=33), and Braden Q score < 16 (n=178). A team of 2 individuals (a nurse champion and another multidisciplinary team member) rounded weekly on identified patients by introducing the project to the bedside nurse and performing a “touch base” on HAC elements recorded in a REDCap survey. Our primary outcome was HAC rates pre-and post-implementation. This process did not serve as HAC audits.

Results: There were 360 rounds conducted with 291 unique patients. Rounding resulted in 294 interventions, including escalation of concerns, direct patient care, resource procurement, and education. The mean time spent per patient was 4.75 minutes (SD=3.78). Patients who underwent HRR were less likely to develop HACs; a chi-squared analysis revealed a negative association between receiving HRR and HACs, χ2(1)= 22.5, p= < 0.001. Compared to the year prior to HRR, the mean rate of overall HACs per 1000 patient days decreased from 6.42 (SD=3.9) to 3.66 (SD=1.7).

Conclusions: Implementation of HRR successfully decreased PICU HACs by an estimated 30 events, equating to potentially $500,000 to $3 million dollars in cost savings. Team member perceptions of HRR were overwhelmingly positive. Future directions of this innovative approach include studying the impact of HRR on unit psychological safety.