Objective Determine the effectiveness of a structured systems-oriented morbidity and mortality conference (MMC) in improving the process of reviewing and responding to adverse events in a pediatric intensive care unit (PICU). Design Prospective time series analysis before and after implementation of a systems-oriented MMC. Setting Single tertiary referral PICU in Baltimore, Maryland. Patients 33 patients discussed before and 31 after implementation of a systems-oriented MMC over a total of 20 MMCs, from April 2013 to March 2014. Interventions Systems-oriented MMC incorporating elements of medical incident analysis. Measurements and Main Results There was a significant increase in meeting attendance (mean of 12 vs. 31 attendees per MMC, p<0.001) after the systems-oriented MMC was instituted. There was no significant difference in the mean number of cases suggested (4.2 vs. 4.6) or discussed (3.3 vs. 3.1) per MMC. There was also no significant difference in the mean number of adverse events identified per MMC (3.4 vs. 4.3). However, there was an increase in the proportion of cases discussed using a standard case review tool but this did not reach statistical significance (27% vs. 45%, p=0.231). Nevertheless, we observed a significant increase in the mean number of quality improvement interventions suggested (2.4 vs. 5.6, p<0.001) and implemented (1.7 vs. 4.4, p<0.001) per MMC. All adverse event categories identified had corresponding interventions suggested after the systems-oriented MMC was instituted compared to before (80% vs. 100%). Intervention-to-adverse event ratios per category were also higher (mean of 0.6 vs. 1.5). Conclusions A structured systems-oriented PICU MMC incorporating elements of medical incident analysis improves the process of reviewing and responding to adverse events by significantly increasing quality improvement interventions suggested and implemented. Future work would involve testing locally adapted versions of the systems-oriented MMC in multiple inpatient settings.

Morbidity and mortality conferences varied widely in structure and process across PICUs in the United States. There was marked disagreement as to whether the morbidity and mortality conference conforms to key elements of medical incident analysis, which might itself be revealing a lack of morbidity and mortality conference structure and consistency. Future research is needed to identify barriers to the use of the morbidity and mortality conference as a patient safety improvement tool and to test strategies for effective implementation linked to improved patient outcomes.

Intrauterine infection with a fetal inflammatory response is a risk factor for neonatal hearing loss while maternal therapies significantly reduced the risk of neonatal hearing loss in very low birthweight infants.

Objectives: With decreasing mortality in PICUs, a growing number of survivors experience long-lasting physical impairments. Early physical rehabilitation and mobilization during critical illness are safe and feasible, but little is known about the prevalence in PICUs. We aimed to evaluate the prevalence of rehabilitation for critically ill children and associated barriers. Design: National 2-day point prevalence study. Setting: Eighty-two PICUs in 65 hospitals across the United States. Patients: All patients admitted to a participating PICU for greater than or equal to 72 hours on each point prevalence day. Interventions: None. Measurements and Main Results: The primary outcome was prevalence of physical therapy– or occupational therapy–provided mobility on the study days. PICUs also prospectively collected timing of initial rehabilitation team consultation, clinical and patient mobility data, potential mobility–associated safety events, and barriers to mobility. The point prevalence of physical therapy– or occupational therapy–provided mobility during 1,769 patient-days was 35% and associated with older age (adjusted odds ratio for 13–17 vs < 3 yr, 2.1; 95% CI, 1.5–3.1) and male gender (adjusted odds ratio for females, 0.76; 95% CI, 0.61–0.95). Patients with higher baseline function (Pediatric Cerebral Performance Category, ≤ 2 vs > 2) less often had rehabilitation consultation within the first 72 hours (27% vs 38%; p < 0.001). Patients were completely immobile on 19% of patient-days. A potential safety event occurred in only 4% of 4,700 mobility sessions, most commonly a transient change in vital signs. Out-of-bed mobility was negatively associated with the presence of an endotracheal tube (adjusted odds ratio, 0.13; 95% CI, 0.1–0.2) and urinary catheter (adjusted odds ratio, 0.28; 95% CI, 0.1–0.6). Positive associations included family presence in children less than 3 years old (adjusted odds ratio, 4.55; 95% CI, 3.1–6.6). Conclusions: Younger children, females, and patients with higher baseline function less commonly receive rehabilitation in U.S. PICUs, and early rehabilitation consultation is infrequent. These findings highlight the need for systematic design of rehabilitation interventions for all critically ill children at risk of functional impairments.

Diagnostic errors in the PICU are not uncommon and potentially cause patient harm. Most appear to be preventable by targeting both cognitive- and system-related contributing factors. Prospective studies are needed to further determine how and why diagnostic errors occur in the PICU and what interventions would likely be effective for prevention.