O2058: Compliance with Implementation of a Pediatric Intensive Care Unit Specific Intrahospital Transport Checklist and Associated Decreased Rates of Adverse Events

Purpose/Objectives: Transport for diagnostic or therapeutic procedures is potentially hazardous for critically ill pediatric patients. The use of safety checklists might help decrease adverse events during these high-risk activities. In a quality improvement initiative, we aimed to describe compliance with a multidisciplinary checklist prior to intra-hospital transport for pediatric ICU patients requiring respiratory support. The secondary aim was to characterize the nature of adverse events and their association with checklist compliance.

Design/Methods: This is a single center retrospective analysis of quality improvement data collected between 2015 and 2021, after implementation of a checklist prior to intrahospital transport for mechanically ventilated patients in the PICU. After multidisciplinary input and unit-wide education, a checklist comprising of plans for personnel, resources, and anticipated problems was implemented. All pediatric medical-surgical ICU patients receiving invasive or non-invasive mechanical ventilation, as well as patients determined to be at high risk by the medical team, qualified for use of the checklist. The checklist was completed in real time by the multidisciplinary clinical team prior to transport. Checklist data and adverse events were recorded immediately after transport by the Respiratory Therapist. We used the Cochrane-Armitage test to evaluate compliance with checklist utilization (percentage of eligible patients with completed intervention) over time. Adverse events were classified as “preventable” or “non-preventable” and categorized into 4 event types: physiologic, sedation-related, equipment-related, and systems-related.

Results: A total of 2720 eligible intra-hospital transports were performed during the 7-year review period; 1989 (73.3%) had completed checklists. On average, 32 checklist-eligible transports were performed per month. Checklist compliance improved over the study period from a mean of 70% to 81% (p=0.008). Overall adverse event rate decreased from 12.4% to 5.9% (16.8 events to 5.9 events per 100 transports, p= 0.002) and non-preventable adverse event rate decreased from 6.9% to 2.4% (8 events to 2.3 events per 100 transports, p=0.002). Of the preventable events recorded, the majority (51%) were systems problems, while non-preventable events were primarily physiologic in nature.

Conclusion/Discussion: Checklist implementation was successful, with improving compliance and decreased adverse events over time. We observed a significant reduction in non-preventable events, particularly events that were related to changes in physiology. We also observed a non-significant downward trend in preventable events. The documentation and classification of adverse events during intra-hospital transport highlighted potential areas for improvement in the timing, resources allocated, and procedural support provided during intrahospital transport of vulnerable PICU patients.