Targeted PICU rounds reduce the rate of healthcare-associated conditions

Rounds focused on critically ill pediatric patients at the greatest risk for developing healthcare-associated conditions (HACs) reduced the rate of specific HACs by nearly 50% at a Colorado hospital, according to a study published in Critical Care Nurse (CCN).

After implementing a high-risk rounding process, Children's Hospital Colorado, Aurora, was able to decrease the mean rate of project-specific HACs in its pediatric intensive care unit (PICU) from 5.41 to 2.89 events per 1,000 patient days. The 48-bed PICU averages 3,500 admissions annually from across the seven states served by the hospital.

"Reducing Hospital-Acquired Conditions in the Pediatric Intensive Care Unit With a High-Risk Rounding Process" details how the interprofessional project team developed criteria for PICU patients at high risk for HACs and created a template script to encourage dialogue with direct care nurses. The article also includes examples of specific interventions performed during the rounds and ways the process revealed trends in practice gaps and opportunities for improvement. 

Co-author Michele Loi, MD, is the PICU director of quality and faculty physician in the PICU at Children's Hospital Colorado and an associate professor of pediatrics at University of Colorado School of Medicine. 

Our high-risk rounds focus on the underlying risks for multiple HACs and extend prevention efforts 'beyond the bundle,' in a collaborative and supportive way. The approach can be easily adapted for changes in patient population and different clinical needs." 

Michele Loi, MD, associate professor of pediatrics, University of Colorado School of Medicine

Before implementation of weekly high-risk rounds, HAC prevention included team members auditing bedside nursing staff for bundle compliance during patient care and conducting apparent cause analysis for all HAC events. 

After implementation, interprofessional rounding teams addressed several HACs simultaneously and offered immediate education and resources if needed. A template script based on a Research Electronic Data Capture (REDCap) survey provided question prompts for the rounding team to cover topics efficiently and collect data. 

Over two years from March 2022 to March 2024, a total of 624 rounds for 488 unique patients was conducted. Rounds resulted in 351 interventions, including escalation of concerns, direct patient care, resource procurement and education. 

Implementation of high-risk rounds reduced the rate of project-specific HACs by 46.5%, which was sustained over the two-year project period. The initiative focused on rates for central line [catheter]-associated bloodstream infection (CLABSI), catheter-associated urinary tract infection (CAUTI), unplanned extubation and pressure injury.

Based on the data analysis, high-risk rounds prevented an estimated 50 HACs during the project period, reducing patient harm and generating significant cost savings.

Patients who received high-risk rounds were less likely to develop an HAC than those who did not receive them. Patients were included in high-risk rounds if they met specific screening criteria, such as extracorporeal membrane oxygenation, continuous renal replacement therapy or endotracheal intubation. 

Trends identified through the high-risk rounds have already spurred additional projects such as a study of unit psychological safety, changes in PICU policies, identification of education topics and a revamp of the shift safety-check process.