Kelsey Stayer
Baylor College of Medicine Texas Children's
Houston
Disclosure information not submitted.
Alyssa Bernardi, DO
Pediatric Critical Care Fellow
Baylor College of Medicine Texas Children's Hospital, United States
Disclosure information not submitted.
Kirby Deshotels, MD (she/her/hers)
Baylor College of Medicine Texas Children's Hospital
Houston, Texas
Disclosure information not submitted.
Divya Sabapathy, MD
Pediatric Critical Care Fellow
Baylor College of Medicine Texas Children's Hospital, United States
Disclosure information not submitted.
Louisa Sethi, DO, MS (she/her/hers)
Fellow PCCM
Baylor College of Medicine Texas Children's Hospital
Houston, Texas
Disclosure information not submitted.
Sarah Walter, MD
Pediatric Critical Care Fellow
Baylor College of Medicine Texas Children's Hospital, United States
Disclosure information not submitted.
Venessa Pinto, MD
Assistant Professor
Texas Childrens Hospital
Houston, Texas
Disclosure information not submitted.
Title: "I Get Better Very SafeLy:" Rounding Checklist Improves Quality Care of Complex Pediatric Patients
Introduction: Critically ill children admitted to quaternary care centers have complex diseases requiring elaborate multispecialty input. We observed that due to frequent team member rotation, multidisciplinary rounding discussions in our ICU were variable in content emphasis and that review of elements related to preventable harm were often overlooked. We aimed to develop and implement a safety checklist to standardize discussion of these elements during rounds.
Methods: For this quality improvement initiative, pediatric critical care fellows identified six elements for checklist inclusion that relate to safe and progressive care of ICU patients. Accordingly, the mnemonic "I Get Better Very SafeLy" was developed to refer to converting Intravenous medications to enteral, Gastrointestinal stress ulcer prophylaxis, Bowel regimen, Venous thromboembolism (VTE) prophylaxis, Skin integrity concerns and necessity of Lines, drains and tubes. Section faculty, fellows and residents were educated on checklist importance and use. Data was collected via direct observation of rounds using the institutional virtual eRounding platform and included measuring checklist use, discussion of each checklist item and if a change was implemented with checklist use. Further PDSA cycles yielded creation of badge cards and distribution of placards on computers as visual aids.
Results: Prior to checklist implementation, 23% (11/47) of patients had 0/6 checklist items addressed during rounds and 100% (47/47) had ≤ 3/6 items addressed. Necessity of lines, drains and tubes was the most addressed item (30% or 14/47 of patients) while identification of skin concerns and need for VTE prophylaxis were least addressed (6% or 3/47 patients, 11% or 5/47 patients). After checklist implementation, 65% (60/92) of patients had ≥ 1 checklist item addressed and 52% (48/92) had ≥ 3 items addressed. All 6 domains saw increases in the percent of patients with each item addressed and patient care was changed due to checklist use 4 times.
Conclusions: Use of a safety checklist on rounds increases the review of quality and safety measures in complex ICU patients. A standardized approach to these measures can facilitate changes in management that may otherwise be overlooked in critically ill children.