IntroductionDelaying the discharge of paediatric intensive care unit (PICU) patients is directly proportional to increased occupancy rate and cost. We aimed to study the process of transferring patients from the PICU to the general ward in order to improve the timeliness of this process while guaranteeing patient safety.MethodsA multidisciplinary quality improvement (QI) team was formed to analyse the transfer process. Several Plan Do Study Act cycles were tested, targeting all steps of the transfer process, and applying turnaround time (TAT)—the duration from the time of clinical transfer decision until the physical transfer of the patient—as an outcome measure, aiming for a TAT of 4 hours.ResultsBaseline results showed that medical transfer decisions by PICU attending physicians were taken late for most patients: only 19% of decisions were made by 08:00 by the on-call team. Average TAT of the transfer process was over 7 hours, with duration ranging from 7 to 17 hours. After implementing all suggested improvement interventions, early decision compliance improved to 59%. TAT improved gradually, starting in January 2017, until it approached our target (284–261 min≈4 hours) in February–May 2017.ConclusionPICU patient transfer process delays can be reduced by early evaluation, timely team communication and proper preparation. It is recommended that all personnel with early involvement avoid unnecessary delays by paying more attention to all process steps, starting with the clinical decision, until the physical transfer. Standardising transfer processes might lead to a decrease in the length of PICU stay, which is a desirable outcome, but this observation needs further exploration.
BackgroundInadequate handover communication is responsible for many adverse events during the transfer of care, which can be attributed to many factors, including incomplete documentation or lack of standardised documentation process. The quality improvement project aimed to standardise the handover documentation process during patient transfer from paediatric intensive care unit (PICU) to the general paediatric ward.MethodsData analysis revealed lack of proper handover documentation with the omission of vital information when transferring patients from PICU to general ward. The quality improvement team assessed the current handover documentation practice using a brainstorming technique during multiple meetings. The team evaluated the process for possible causes of incomplete handover documentation, framed the existing challenges, and proposed improvement interventions, including a standardised handover form and conducting education sessions for the new proposed process. The main quality measures included physician’s compliance with handover documentation elements, physician’s satisfaction and PICU emergency readmission rate within 48 hours.ResultsPhysician compliance to handover documentation improved from 29.5% to 95.5% before and after implanting the improvement interventions, respectively. The level of physician satisfaction with the quality of communicated information during the handover process improved from 47.5% to 84%, and the PICU emergency readmission rate declined from 3.8% to zero after all improvement interventions were implanted.ConclusionImplementation of standardised handover form is essential to improve physician compliance for clear handover documentation and to avoid data omission during the patient transfer process. Documented handover in patient’s medical record has positive impact on physician satisfaction when managing patients recently discharged from PICU.
Background Cardiopulmonary arrest is an uncommon event in pediatric patients. Additionally, physicians-in-training see far fewer cardiopulmonary arrest events. Therefore, they have limited confidence in their resuscitation skills. Mock code training with active participation and debriefing may be an effective tool to fill this gap in experience. The aims of the study were to assess the impact of a mock code simulation program on patient outcome for children with cardiopulmonary arrest in a tertiary pediatric academic center and provide evidence that code simulations can improve the quality of cardiopulmonary resuscitation (CPR). Methods This was a retrospective cohort study conducted in a tertiary academic center. This study had two phases: Phase 1 before the mock code simulation program began (pre-intervention) and Phase 2 after the mock code program began (post-intervention). The data were collected from pediatric patients with cardiopulmonary arrest during the study period who met the inclusion criteria, and variables included the survival rate at hospital discharge, CPR initiation time, time to the first dose of epinephrine, and the adherence rate to American Heart Association (AHA) guidelines. Results A total of 13 patients in the pre-intervention period and 19 patients in the post-intervention period were included. The results showed a significant improvement in team performance represented by a decrease in CPR initiation time post-intervention and improvement in AHA adherence; however, the results did not show a significant difference in the survival rate or mortality within 28 days of the cardiopulmonary arrest event between the pre- and post-intervention groups. Conclusions Mock code simulation was a helpful tool to enhance team performance and improve the quality of cardiac resuscitation and cardiac arrest recognition, while its impact on the survival rate was not significant in our study.
Aim The aims of the study were to identify supracondylar fracture cases, identify any differences in management between the pre- and post-COVID period, as well as compare local management to BOAST guidelines. Method Cases were retrospectively identified using electronic patient records, imaging, theatre records and clinic letters. Cases were identified between 1st of December 2019 – 30th December 2020. The Pre-COVID period was defined as before 15th of March 2020. The Post-COVID period was defined as after 15th of March 2020. Inclusion criteria: any paediatric supracondylar fracture requiring conservative or surgical management. Exclusion criteria: any adult cases. Data analysis and graphics were produced on Microsoft Excel. Results A total of 22 cases were identified. Time to operation Pre-COVID: 1 day vs Post-COVID 2 days (p < 0.05). Only 30% of cases had good neurovascular status documentation. Using the Gartland Classficiation – Type I:2, Type II:10, Type III:9, Type IV:1. Type of Fixation – MUA: 3, K-wires: 18, Plate and screws: 1. All Type I fractures were treated with K-wires. Cast duration for MUA 4 weeks vs K-wire 5 weeks (p-value< 0.05). Only 2/22 cases were referred to physiotherapy, whilst only 1 case required revision surgery. Conclusions MUA was not the treatment of choice for Type I fractures against BOAST guidelines. MUA offered a shorter duration in cast compared to K-wires. There was a statistically significant increase in time to operation between the Pre-COVID to Post-COVID Period. There is a need for better documentation for neurovascular status.
BackgroundHuman resource shortages are a global challenge in the healthcare system and create barriers in providing timely follow-up visits for paediatric patients discharged recently from the intensive care unit (ICU). Relying on experienced intensive care nurses to provide follow-up services for patients post paediatric ICU (PICU) transfer has been proven a cost-effective and safe practice. This study aimed to achieve no delays in initiating follow-up visits and to assess the safety of implementing a nurse-led follow-up service.MethodsPlan–Do–Study–Act cycle was used targeting to achieve no delay in initiating follow-up visits and to maintain the safety of the patients. This cycle resulted in the implementation of a nurse-led follow-up service, which is under the provision of a paediatric rapid response team (RRT). Fifteen PICU nurses were trained in their new roles and responsibilities. Service databases were established to track and trend the frequency of visits, service safety measures and clinical deterioration.ResultsAfter the implementation of the nurse-led follow-up service, we achieved no delays in initiating the follow-up visits. 45% (n=487) of patients received a nurse-led follow-up visit service. Safety measures demonstrated 0.21% (n=1) recorded events of RRT activations during the follow-up service. RRT activation within 48 hours from service discharge was 1.2% (n=6), and readmission to PICU within 48 hours was 0.8% (n=4). No cardiopulmonary arrest event was recorded for patients under the nurse-led follow-up service during the service, postservice discharge or postreadmission to PICU.ConclusionsImplementing nursing-led service has been shown to be safe, efficient and provides patients with timely visits post-PICU discharge.
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