(688) Implementation of PICU Intrahospital Transport Checklist and Associated Decrease in Adverse Events

Introduction: Transport is potentially hazardous for critically ill pediatric patients. The use of safety checklists has been shown to decrease adverse events in other environments. This quality improvement (QI) initiative aimed to describe compliance with a checklist prior to intrahospital transport for PICU patients requiring respiratory support and trends in adverse event rates. The secondary aim was to characterize the nature of adverse events as preventable or non-preventable.

Methods: This is a single center retrospective analysis of QI data collected 2015-2021 after implementation of an intrahospital transport checklist for ventilated patients in the PICU. Patients receiving invasive or non-invasive mechanical ventilation and those deemed high risk by the medical team qualified for use of the checklist. The checklist was completed by the multidisciplinary team before transport. Checklist data and adverse events were recorded after transport by respiratory therapy. The Cochrane-Armitage test was used to evaluate checklist utilization compliance over time. Adverse events were classified as preventable or non-preventable and categorized into 4 event types: physiologic, sedation, equipment, and systems.

Results: 2720 eligible intrahospital transports were performed during the 7-year review period; 1989 (73.3%) had completed checklists. Checklist compliance improved from a mean of 70% to 81% (p=0.008). Overall adverse event rate decreased from 16.8 to 5.9 events per 100 transports (p= 0.002) and non-preventable adverse event rate decreased from 8 to 2.3 events per 100 transports (p=0.002). There was no significant association of adverse events with time of day of transport or patient diagnosis. Of the preventable events, 51% were systems issues, while non-preventable events were primarily physiologic.

Conclusions: Checklist implementation was successful, with improved compliance and decreased adverse events over time. We observed a significant reduction in non-preventable events and a non-significant but downward trend in preventable events. The documentation and classification of adverse events during transport highlights potential areas for improvement in the timing, resources allocated, and support provided during intrahospital transport of PICU patients.