SAMURAI PICU: Situation Awareness incorporating Multidisciplinary Teams Reduce Arrests In the Pediatric ICU

项目摘要 儿科院内心脏骤停几乎完全发生在儿科重症监护病房， 每年都有数千名住院儿童受到影响。虽然心脏骤停的生存结果 改善，超过一半的这些儿童将在出院前死亡，使预防成为最好的 改善儿科患者安全的方法。在我们的单中心先前的工作中， SAMURAI PICU（结合多学科团队的情况意识减少逮捕， PICU）捆绑提高了高危患者的早期识别，增加了共享情况 意识，并支持风险缓解计划，导致IHCA事件减少50%以上 需要心肺复苏使用强调共享的创新流程 通过自动化临床决策支持和风险缓解，我们将使用 以用户为中心的设计方法，以适应，实施和评估的可行性， SAMURAI PICU在其他儿科机构的有效性。我们假设身份认同 通过使用我们的自动化临床 决策支持工具，并将这种高风险状态整合到日常安全会议中， 提高了对共同情况的认识，从而减少了心脏骤停事件。我们将 利用五个中心的务实前瞻性混合1型有效性-实施研究 利用儿科复苏质量协作的现有基础设施， 以下具体目标：1）在每个干预部位调整SAMURAI PICU套件， 通过以用户为中心的设计方法，2）实现SAMURAI PICU捆绑包 以混合阶梯式楔形方式，并评估束减少CPR的有效性 PICU的事件。这项拟议的研究是重要的，它有可能告知和 改变心脏骤停预防领域，并最终预防与住院相关的死亡 心脏骤停为成千上万的儿童在未来显着改善儿科患者 安全为代价的

PROJECT SUMMARY Pediatric in-hospital cardiac arrest occurs almost exclusively in pediatric intensive care units and affects thousands of hospitalized children each year. While cardiac arrest survival outcomes have improved, more than half of these children will die prior to discharge making prevention the best approach to improve pediatric patient safety. In our single center prior work, the use of the SAMURAI PICU (Situation Awareness incorporating MUltidisciplinary Teams Reduce Arrests In the PICU) bundle improved early identification of high-risk patients, increased shared situation awareness, and supported risk mitigation plans leading to a >50% decrease in IHCA events requiring cardiopulmonary resuscitation. Using an innovative process of emphasizing shared situation awareness through automated clinical decision support and mitigation of risk, we will use a user-centered design approach to adapt, implement, and assess the feasibility and effectiveness of SAMURAI PICU at other pediatric institutions. We hypothesize that identification of PICU patients at high risk for in-hospital cardiac arrest through the use of our automated clinical decision support tool and integration of this high-risk status in daily safety huddles will lead to improved shared situation awareness and subsequent reduction in cardiac arrest events. We will utilize a five-center pragmatic prospective Hybrid Type 1 effectiveness-implementation study leveraging the existing infrastructure of Pediatric Resuscitation Quality Collaborative to evaluate the following specific aims: 1) adapt the SAMURAI PICU bundle at each intervention site to fit local context through a user-centered design approach, 2) implement the SAMURAI PICU bundle in a hybrid stepped wedge fashion and evaluate the effectiveness of the bundle to reduce CPR events in the PICU. This proposed research is significant it has the potential to inform and transform the field of cardiac arrest prevention and ultimately prevent death related to in hospital cardiac arrest for thousands of children in the future significantly improving pediatric patient safety.