Fashina, Oluwatomini

Introduction As part of the Society of Critical Care Medicine's Pediatric ICU Liberation Campaign Collaborative, Mayo Clinic developed a daily physician-led rounding checklist to promote timely de-escalation of ICU support and proactive measures to prevent iatrogenic conditions. We hypothesized that implementing this checklist would be feasible and would reduce missed opportunities to optimize care through both de-escalation and initiation of key preventive tasks. Methods We conducted a prospective study in a 16-bed medical/surgical PICU at a quaternary academic center over a 300-day period from May 2017 to March 2018. A 15-task daily rounding checklist was integrated into standard patient-centered rounds for every admitted patient to prompt physicians to address common de-escalation and preventive care tasks. For each task, physicians documented whether it had already been addressed during rounds, was not applicable to the patient, or the checklist directly prompted a plan modification. Trends in checklist compliance and the frequency/type of plan modifications were assessed in 60-day intervals to evaluate sustainability over time. Results 1,710 rounding checklists were completed across 2,424 patient-days (71% compliance). The checklist prompted 198 documented plan modifications from 9% of all completed checklists. The most frequent modifications involved initiating a bowel regimen ( n = 47), converting intravenous to enteral medications ( n = 32), initiating gastrointestinal prophylaxis ( n = 30), consulting rehabilitation services ( n = 18), and restarting home medications ( n = 18), which together accounted for 73% (145/198) of all modifications. Discussion Implementation of a daily rounding checklist was feasible, achieved acceptable compliance, and identified 198 opportunities for timely de-escalation and proactive care in a complex PICU environment. Although overall compliance did not meet the a priori >75% target across the entire study period, early adoption exceeded this threshold and later decline highlighted sustainability challenges. This initiative demonstrates the potential of structured physician-led checklists to standardize care and reduce iatrogenic risk in pediatric critical care.

Objective: The Society of Critical Care Medicine PICU Liberation ABCDEF (A–F) Campaign Collaborative aimed to implement best practices for analgesia (A), breathing (B), comfort/consciousness (C), delirium (D), early mobilization (E), and family engagement and empowerment (F). Our post hoc study of Mayo Clinic data sought to compare the pre-implementation rounding process, which used a nursing script organized by organ systems, with a novel, liberation-focused rounding process emphasizing A–F bundle elements. Design: Secondary analysis of pre- vs. post-implementation surveys collected by independent observers during rounds. Setting: Medical/surgical PICU in a quaternary-care, academic medical center during April to July 2017. Subjects: The observed participants included PICU physicians, nurses, respiratory therapists, pharmacists, and dietitians. Interventions: None. Measurements and Main Results: Survey responses from 145 team members pre-implementation and 67 post-implementation showed improved team satisfaction, communication, and understanding of daily plans (all p < 0.05). Respondents reported an increased frequency of discussions on bundle components A–E (all p < 0.01). Observations of 41 pre-implementation and 46 post-implementation rounds showed an increase in the frequency of discussion of all components of the bundle (all p < 0.01). However, this finding was not at the expense of increased duration of individual rounds since we failed to find a difference in pre- vs. post-implementation duration per patient (480 vs. 544 s per patient, p = 0.20). Conclusions: In 2017, around the time of introducing the nurse-led PICU Liberation rounding process to our practice, we found that after implementation, there was an associated increase in discussions about bundle elements and improved communications and satisfaction in team members.

Abstract Introduction: Historically, children undergoing cardiac catheterization have been managed with general endotracheal anesthesia (GETA). However, recent practice has favored general anesthesia with total intravenous anesthesia (TIVA). This study compares procedural outcomes in the pediatric cardiac catheterization laboratory (PCCL) for children undergoing low-risk cardiac catheterization with GETA vs. TIVA. Methods: We reviewed all patients aged 1–12 years, who underwent outpatient diagnostic or simple interventional catheterization from January 2016 – September 2023. Patients were divided into cohorts by type of anesthesia (GETA vs. TIVA). The primary outcome measure was total patient time in the PCCL (“door-to-door” time). Secondary outcomes were procedure duration (“sheath time”), length of hospital stay, and the major adverse event (MAE) rate. Results: A total of 401 patients were included. Of these patients, 226 underwent GETA and 175 underwent TIVA. There were 148 interventional procedures and 72 patients had single-ventricle physiology. There was no significant difference between the two cohorts in terms of demographic factors such as age, weight, procedure indication and physiological complexity as well as outcomes such as sheath time, hospital stay and MAE. However, the average door-to-door time of the TIVA cohort was 25 minutes shorter than the GETA cohort (p < 0.001). Conclusions: In this single center, retrospective study of anesthesia management for children undergoing low-risk cardiac catheterization, TIVA is associated with significantly shorter door-to-door time in the PCCL without an increase in procedure duration, hospital stay, or rate of complications. These findings have potential clinical significance supporting increased use of TIVA during pediatric cardiac catheterization.