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

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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.