697 - Associations between Adverse Events and Urgency of Intensive Care Unit Triage in Hospitalized Children

Friday, April 28, 2023

5:15 PM – 7:15 PM ET

Poster Number: 697
Publication Number: 697.153

Lisa Rickey, Boston Children's Hospital, Boston, MA, United States; Maureen Pimentel, Boston Children's Hospital, Boston, MA, United States; Kelly Zakar, Boston Children's Hospital, Boston, MA, United States; Sarah C. McBride, Harvard Medical School, Boston, MA, United States; Gabrielle D'Ambrosi, Boston Children's Hospital, Somerville, MA, United States; Christopher P. Landrigan, Boston Children's Hospital, Boston, MA, United States

Presenting Author(s)

Lisa Rickey, MD

Hospital Medicine Fellow
Boston Children's Hospital
Boston, Massachusetts, United States

Background: Adverse events (AEs) occur frequently in the inpatient setting, especially around escalations of care. Previous studies have demonstrated high rates of AEs associated with unplanned transfers from inpatient units to Intensive Care Units (ICU). In our institution activation of a tiered rapid response team (RRT) facilitates inpatient ICU triage by non-urgent (ICU Eval) or emergent (ICU Stat/Code Blue) mechanisms. We sought to measure rates of adverse events before and after escalations of care, and to assess whether they varied by the urgency level of ICU triage.

Objective:

To assess whether the urgency of ICU triage is associated with differences in the rate, severity, or preventability of AEs prior to and immediately following ICU transfer.

Design/Methods: Retrospective study of patients < 18 years admitted to inpatient medical and surgical units from January 2018-December 2019 with unplanned ICU transfers. Patients with RRT activations without transfer were also evaluated for comparison. Primary reviewers performed a focused chart review, informed by a modified GAPPS trigger tool, from admission to RRT activation (pre-transfer), and during the first 48 hours of ICU admission (post-transfer). All suspected AEs identified on primary review underwent secondary review by two independent physicians who made final judgments regarding case classification (91% agreement, K=0.63), severity level, and preventability.

Results: Among a preliminary subset of 53 patients, 84.9% (n=45) were triaged as ICU Eval and 15.1% (n=8) as ICU Stat/Code Blue with similar rates of ICU transfer (68.9% and 62.5%, respectively). In total 70 AEs were identified (1.3 AE per patient). Most AEs resulted in temporary harm requiring initial or prolonged hospitalization (NCC-MERP Level F, 66.1%) or interventions required to sustain life (H, 28.8%) with similar rates between triage mechanisms. In the pre-transfer period 57.6% of all AEs were preventable. In the post-transfer cohort, all AEs (n=11) occurred in patients transferred via ICU Eval, and most were low in severity (E, 36.4% and F, 45.5%) and not preventable (63.4%).

Conclusion(s): We identified high rates of AEs among patients requiring ICU triage and transfer. Rates of AEs were similar regardless of the mechanism of transfer.