• Maya Dewan, Blaise Soberano, Tina Sosa, Matthew Zackoff, Philip Hagedorn, Patrick W Brady, Ranjit S Chima, Erika L Stalets, Lindsey Moore, Maria Britto, Robert M Sutton, Vinay Nadkarni, Ken Tegtmeyer, and Heather Wolfe.
• Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH.
• Pediatr Crit Care Me. 2022 Jan 1; 23 (1): 4124-12.

ObjectivesTo use improved situation awareness to decrease cardiopulmonary resuscitation events by 25% over 18 months and demonstrate process and outcome sustainability.DesignStructured quality improvement initiative.SettingSingle-center, 35-bed quaternary-care PICU.PatientsAll patients admitted to the PICU from February 1, 2017, to December 31, 2020.InterventionsInterventions targeted situation awareness and included bid safety huddles, bedside mitigation signs and huddles, smaller pod-based huddles, and an automated clinical decision support tool to identify high-risk patients.Measurements And Main ResultsThe primary outcome metric, cardiopulmonary resuscitation event rate per 1,000 patient-days, decreased from a baseline of 3.1-1.5 cardiopulmonary resuscitation events per 1,000 patient-days or by 52%. The secondary outcome metric, mortality rate, decreased from a baseline of 6.6 deaths per 1,000 patient-days to 3.6 deaths per 1,000 patient-days. Process metrics included percent of clinical deterioration events predicted, which increased from 40% to 67%, and percent of high-risk patients with shared situation awareness, which increased from 43% to 71%. Balancing metrics included time spent in daily safety huddle, median 0.4 minutes per patient (interquartile range, 0.3-0.5), and a number needed to alert of 16 (95% CI, 14-25). Neither unit acuity as measured by Pediatric Risk of Mortality III scores nor the percent of deaths in patients with do-not-attempt resuscitation orders or electing withdrawal of life-sustaining technologies changed over time.ConclusionsInterprofessional teams using shared situation awareness may reduce cardiopulmonary resuscitation events and, thereby, improve outcomes.Copyright © 2021 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

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