(1229) The Use of Enhanced Situation Awareness to Reduce Failure to Rescue Events

Introduction: Situation awareness (SA) reduces in-hospital cardiac arrests (IHCA). Since 2017, we have enhanced SA in the PICU using clinical decision support to identify high-risk “Watcher” patients, bedside mitigation plans, and daily huddles. We have seen a reduction in IHCA rate. We hypothesized enhanced SA would reduce failure to rescue (FtR) events and Watchers would receive improved CPR quality and have enhanced rescue rates.

Methods: We conducted a retrospective data review from a prospective observational cohort of all IHCA events in the PICU from July 2017 to June 2023. IHCA was defined as a patient’s first event during admission with ≥2 minutes of CPR; FtR was defined as death prior to PICU discharge. Our primary outcome metric was rate of FtR events per 1000 patient days tracked via a U-chart. Patient results were assessed with Chi Squared, Fisher’s Exact, and Mann-Whitney U tests.

Results: There were 94 events occurred within the study period, 55% (n=52) met FtR criteria. A decrease from 1.53 to 0.79 FtR events per 1000 patient days was seen. Increased age was associated with increased rates of FtR [5.5 years (IQR 1.0-13.3) vs 1.4 years (IQR 0.7-9.0), p=0.046] with no other significant demographic differences. Watcher status was not associated with a difference in FtR rates (p=0.86). Between rescue and FtR groups, significant differences were noted in watcher identification method (p=0.03). 57% of rescued patients were identified via clinician intuition compared to 37% of FtR patients. CPR quality data was available for 70% (n=66) of events. No association was found between watcher status and CPR quality when assessing compression fraction ( < 80% vs. ≥80%, p=0.75), compressions meeting depth target (≤20% vs. 20-50% vs. ≥ 50%, p=0.41), or compressions meeting the rate target (≤50% vs. 50-75% vs. ≥75%, p=0.14).

Conclusions: Watcher status was not associated with decreased FtR rates or CPR quality. However, since the initiation of SA efforts, we observed a global decrease in FtR rate. Rescued watcher patients were more likely to be identified by clinician intuition, suggesting rescue rates are higher for clinician intuition identified Watchers. Further work to improve resuscitation efficiency and efficacy will require ongoing clinical support tool augmentation and targeting bedside training.