Clinical Outcomes of a Pediatric Safety Surveillance Program
Murchie, W.E., Roberts, J.S., Leininger, R.J., Clifton, H., Smith, S. Seattle Children’s Hospital, Seattle, WA
Background: A safety surveillance program was created to provide proactive acuity surveillance and
critical care expertise for acute care patients and to reduce severe clinical deteriorations resulting in
transfer to the intensive care unit (ICU) and resuscitation. Methods: A Recognized Illness Severity in
Kids (RISK) nurse role was implemented in March 2013. The RISK nurse is a dedicated 24/7 ICU nurse
who proactively meets with acute care staff, monitors acute care, and is the nurse responder for rapid
response team calls. Their focus was early identification of patients at risk for clinical deterioration using
a modified pediatric early warning score and clinical triggers thus facilitating prompt nursing and
medical intervention. Training included parent perspectives, didactic courses, and simulation. A
Transfer Requiring Intensive Care Practice (TRIP) was used to define a clinical change in a patient’s status
which required both transfer to the ICU and resuscitation (non-invasive positive pressure ventilation,
intubation, or vasoactive support) within two hours. This facilitated prompt nursing and provider
intervention to prevent TRIP’s. TRIP rate, ICU average length of stay (ALOS), and 28 day mortality was
compared pre-program implementation (2012) and post-program implementation (2014). Results:
Between 2012 and 2014, the TRIP event rate decreased from 1.78 per 1000 non-ICU patient days to 1.1
per 1000 non-ICU patient days. ICU ALOS for patients meeting TRIP criteria decreased from 10.61 days
to 7.88 days, while non-TRIP events ICU ALOS decreased from 7.21 days to 4.71 days. Twenty eight day
mortality for patients meeting TRIP criteria decreased from 14.3% to 6%. Non-TRIP event 28 day
mortality decreased from 4% to 3.4%. In 2012 rapid response calls totaled 455. Rapid response calls
increased to a total of 708, a 55.6% increase, in 2014. The ICU transfer rates for our RRT calls increased
from 33.5 % to 55.2%. Conclusions: Substantial reductions in TRIP events, ICU ALOS, and 28 day
mortality were seen after implementing a pediatric safety surveillance program. In addition, increased
safety surveillance was associated with an increase in RRT calls and ICU transfer rate.
The authors have no conflicts of interest to disclose.
Wendy Murchie, MN, RN, CCRN
Joan Roberts, MD
Wendy.murchie@seattlechildrens.org
Joan.roberts@seattlechildrens.org