Quality improvement program sustainably prevents cardiac arrest in pediatric ICUs
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Key takeaways:
- A cardiac arrest prevention quality improvement program provided sustained benefits in participating hospitals.
- The analysis yielded a novel sustainability score to gauge hospital efforts at quality improvement.
A multidisciplinary quality improvement program to prevent cardiac arrest in the pediatric ICU provided sustained improvement in participating centers out to 2 years, researchers reported.
A long-term analysis of the effects of a cardiac arrest prevention (CAP) quality improvement program among participating hospitals was published in JAMA Network Open.
“The CAP quality improvement project was a multicenter, collaborative initiative aimed at implementing a clinical practice bundle in an effort to reduce in-hospital cardiac arrest rate in cardiac patients who were cared for within cardiac intensive care units of 15 Pediatric Cardiac Critical Care Consortium participating centers,” Dana Mueller, MD, a pediatric cardiac intensivist and associate clinical professor at Rady Children’s Hospital-San Diego, told Healio. “Pediatric Cardiac Critical Care Consortium is a quality improvement project collaborative registry currently comprised of more than 75 hospitals, with an overarching goal of improving outcomes in patients with critical pediatric and congenital CVD. The centers involved in the initial CAP quality improvement project demonstrated a 30% risk-adjusted reduction in in-hospital cardiac arrest rate during the initial study period.”
The five-element bundle included twice-daily multidisciplinary “safety huddles,” “just-in-time” training for rescue during in-hospital cardiac arrest and discussion of vital signs, presedation for noxious stimuli, emergency medication and a formal code review within 2 weeks of a cardiac arrest event.
As Healio previously reported, the CAP quality improvement project using a low-technology prevention practice bundle in pediatric ICUs significantly decreased in-hospital cardiac arrest over 18 months compared with control hospitals.
For the present study, Mueller and colleagues assessed whether improvements observed during the initial study period were sustained 2 years after the conclusion of the trial.
The researchers analyzed data from 17 Pediatric Cardiac Critical Care Consortium CAP quality improvement-participating hospitals via web-based surveys administered 2 years after the initial study.
Risk-adjusted rates of incident pediatric in-hospital cardiac arrest were compared between study eras.
Sustained reduction of in-hospital cardiac arrest
The researchers reported no clinically meaningful differences in demographic and admission characteristics between the 13,082 CAP era admissions from July 2018 to 2019, and the 16,284 follow-up admissions from March 2020 to February 2022 (total mean age, 5 years; 56% boys).
Mueller and colleagues observed no significant differences in risk-adjusted incident in-hospital cardiac arrest between the CAP era compared with the follow-up era (2.8% for CAP era vs. 2.8% for follow-up era; OR = 1.03; 95% CI, 0.89-1.19).
“This follow-up analysis was instrumental in determining if continued engagement and effective sustainability of an established quality improvement process could be effective in ongoing reduction of in-hospital cardiac arrest rate,” Mueller told Healio. “This paper highlighted that sustained reduction in in-hospital cardiac arrest rate is both feasible and sustainable. Both implementation strategies and continued engagement in CAP processes during the follow-up study era were associated with this sustained improvement.”
Novel CAP-related quality improvement score
Additionally, the 2-year follow-up survey provided a novel hospital-specific quality improvement sustainability score, reflective of the sum CAP quality improvement work performed at a site, according to the study.
Mueller and colleagues observed that a lower hospital sustainability score was associated with higher likelihood for pediatric in-hospital cardiac arrest during the follow-up era compared with the CAP era, with a correlation coefficient of 0.58 (P = .02).
Moreover, five hospitals had 1% or more increases in risk-adjusted in-hospital cardiac arrest during the follow-up era, and each had significantly lower sustainability scores or reported less persistent engagement with CAP-related quality improvement processes.
“The CAP practice bundle can certainly be expanded to other hospitals, as the infrastructure has been created and its effectiveness has been demonstrated,” Mueller told Healio. “There are some newer Pediatric Cardiac Critical Care Consortium centers that are still adopting these practices, and the hope is that as these practices are both sustained and are more widely adopted, patients will continue to benefit.
“With any change in clinical practice, there is always a required shift in workplace culture, which can take time. The original CAP bundle was designed with this in mind, and presented ways to promote team engagement and project buy-in, which highlights the importance of these practices when developing a quality improvement project,” she said. “The idea of thinking about sustainability on the front end of project design can also help to address and mitigate some of these cultural barriers and promote longer-term success.”
For more information:
Dana Mueller, MD, can be reached at 3020 Childrens Way, First Floor, San Diego, CA 92123.
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