(717) Proactive Critical Care Outreach Team Enhances Identification of Patients at Risk for Deterioration

Introduction: Unrecognized deterioration poses significant risk of harm to hospitalized children. Proactive surveillance by a critical care outreach team (CCOT) can promote early recognition of deterioration but is uncommon in pediatric rapid response systems (RRS). We deployed a CCOT in 2019 to augment our RRS, which includes a ‘watcher’ program; clinician concern program; early warning score; medical emergency team; and code blue team. We hypothesized that CCOT rounds enhances identification of at-risk ward patients not detected by other RRS elements.

Methods: CCOT is staffed by an ICU RN, RT, and attending, and rounds at 9am, 4pm, and 2am. During rounds, CCOT meets with each ward charge RN about at-risk patients identified by the RRS, to screen for deterioration and coach on use of RRS escalation systems. Bedside RNs participate for ‘watchers.’ We observed 20 morning rounds across 8/2021-12/2021. We tracked topics discussed beyond screening/coaching and additional care provider participation. We labeled communication on rounds as ‘standard discussion’ (SD) if basic procedures were followed and ‘augmented discussion’ (AD) if care providers prompted discussion of additional patients (not identified by the RRS). We used Fisher’s exact test to compare SD and AD. We performed qualitative analysis using chart review and grounded theory principles to identify key themes for patients identified in AD.

Results: We observed 348 rounds on 21 units. The most frequently discussed topic beyond screening/coaching was active clinical concern (39%) and 22 rounds (6%) involved additional providers (most often frontline clinicians). AD occurred in 36 (10%) rounds. Compared to SD, AD more often addressed active clinical concerns (75% vs 35%, p< 0.01), warning signs of deterioration (17% vs 6%, p=0.03), and escalation strategies (19% vs 8%, p = 0.03). AD also more frequently involved additional providers (17% vs 5%, p=0.01). In qualitative analysis, all patients identified in AD had identifiable risk factors for deterioration, including early signs of deterioration.

Conclusions: Through frequent AD focused on recognition and escalation of clinical concerns for deterioration, CCOT rounds enhanced identification of patients not detected by our RRS. Future study will assess the impact of CCOT implementation on patient outcomes.