Children's Hospitals Today - Fall 2022 - 4

ROUNDS / FROM EXPERIENCE
Bundle of
success
A highly replicable
prevention bundle
reduces cardiac arrest
by 30% in the CICU.
BY BO MCMILLAN
D
espite years of investment
to improve CPR
and post-resuscitation care,
many experts in the field
have considered in-hospital
cardiac arrest (IHCA) a
largely unavoidable outcome
for some children in cardiovascular
intensive care units
(CICUs). A recent initiative
by 15 children's hospitals
challenges that notion.
A simple, low-technology
cardiac arrest prevention
practice bundle reduced
IHCA incidence by an
average of 30% across the
participating centers. The
results, published in JAMA
Pediatrics, exceeded a targeted
25% reduction, and
the practices used can be
replicated in any institution,
say project leaders Jeffrey
Alten, M.D., attending physician
at Cincinnati Children's
Hospital Medical Center
CICU, and Michael Gaies,
M.D., medical
director of the
Acute Care
Cardiology Unit
at Cincinnati
Children's.
The bundle,
of
composed
five elements,
was designed
to promote
situational awareness and
communication to recognize
and mitigate deterioration
in high-risk patients.
Each element of the bundle
was specifically chosen
to be minimal in cost and
technology independent,
allowing CICUs to adapt it
THIS PROJECT WAS
ABLE TO PREVENT
CPR IN ALMOST
200 HIGH-RISK
CHILDREN.
to their local system, quality
improvement resources and
clinical workflow.
The project for creating the
bundle came
from a quality
improvement
initiative conducted
within
a collaborative
learning network
of CICU
teams
across
the Pediatric
Cardiac Critical
Consortium (PC4), which
aims to improve the quality
of care for patients with critical
pediatric and congenital
cardiovascular disease. PC4
is part of Cardiac Networks
United,
a
collaborative
pediatric and congenital
cardiovascular research and
improvement network.
" This study represents the
culmination of years of effort
by so many within PC4, " says
Gaies, who was the founder
and executive director of
PC4 during the study. " We
collaborated with hospitals
across the country to collect
data and understand variation
in performance on IHCA
prevention. Leaders from
these institutions then came
together to improve the quality
of care across hospitals. "
IMPLEMENTATION
AND ANALYSIS
Monthly webinars led by
project leaders featured
education, data review and
collaborative learning to
empower
teams toward
4
CHILDREN'S HOSPITALS TODAY Fall 2022
Children's Hospitals Today - Fall 2022

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