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Rapid response teams (RRTs) improve outcomes for patients through early escalation of care. However, subtle signs of clinical deterioration in children may not be consistently recognized by the bedside acute care nurse and therefore the RRT may not be activated. The Pediatric Early Warning Score (PEWS), an evidence-based tool, provides nurses with a mechanism for early detection using quantitative data. We describe our process and outcomes of implementing and sustaining the use of PEWS at the unit and organizational level using the Plan-Do-Check-Act methodology for performance improvement. Our outcome data indicate that cardiopulmonary arrests were reduced by 31% at the pilot unit level and subsequently 23.4% at the organizational level. Data also suggest that bedside nurses effectively escalated patient care needs without activating RRTs (19.4% reduction in RRT activations after PEWS implementation). Strategies to sustain the positive outcomes of PEWS at the unit and organizational levels are also described.

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Introduction: Despite the well-known dangers of working in the healthcare industry, healthcare organizations have historically accepted workplace injuries as business as usual. In 2017, Children’s National Hospital began our Employee and Staff Safety program to drive down the employee injury rate and address this disturbing industry trend. Methods: With guidance and support from executive leadership, we created an Employee and Staff Safety program that aligned employee safety work with existing patient safety and quality improvement efforts. Team leads collected and analyzed baseline employee injury data and identified areas of highest injuries. Dedicated subcommittees focused on five specific areas: slips, trips, and falls; sharps injuries; blood and body fluid exposures; verbal and physical violence; and overexertion injuries. Subcommittees established aims, identified key drivers, and brainstormed interventions for tests of change. Results: Because the inception of the Employee and Staff Safety program, Children’s National has seen significant reductions in our Days Away Restricted or Transfer (DART) rate. The DART rate shows a sustained 37% reduction since the baseline period of FY16–FY17 (1.48 injuries/200,000 h worked to 0.93 injuries/200,000 h worked). The regression trend shows a significant decrease (38.3%) in DART injuries, from 1.544 to 0.952 over 56 months; P = 0.016. Conclusions: Active leadership support and analyzing data on specific employee harm areas coupled with targeted interventions, helped improve Children’s National’s DART rate. The Employee and Staff Safety program’s success in utilizing patient safety and quality improvement tools creates a generalizable framework for other hospitals to advance their high-reliability journey.