144 - Variation in Charted Vital Signs Upon Unit Transfer in Children with Chronic Ventilator Dependence

Poster Number: 144
Publication Number: 144.304

Jessie C. Benson, Texas Tech University Health Sciences Center School of Medicine, Plano, TX, United States; Guixia Huang, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Md M. Hossain, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Nathan M. Pajor, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States

Background: Vital signs are used to assess a patient’s clinical status, communicate objective information at time of unit transfer, and inform early warning systems that predict deterioration. In most pediatric hospitals, vital signs are charted or validated manually by bedside staff, potentially introducing unintended error into the process. 

Objective: Children with chronic ventilator dependence initiating new ventilator support require prolonged hospitalization and have chronic rather than acute disease trajectories at the time of transfer from an intensive care unit (ICU) to a transitional care unit (TCU), representing an ideal population to examine differences in vital sign charting practice between units. We hypothesize that despite these factors, this patient population will show significant differences in charted vital signs upon unit transfer.

Design/Methods: In a retrospective chart review, we identified a cohort of patients less than 1 year of age, admitted and initiated on chronic ventilator support. For each patient, a 15-day timeframe was isolated that included transfer date from ICU to TCU and 7 days pre/post-transfer. Vital signs (heart rate, respiratory rate, and oxygen saturation) were extracted from the electronic health record. Mixed effects linear models were used to compare mean and variation of each vital sign on the day before and after transfer. Data on infection testing, acute events (including ICU readmissions), ventilator support changes, medication changes, and imaging were also collected.

Results: The total cohort of 77 patients (34 female) had an average age of 190 days at time of transfer. Population mean oxygen saturation was lower (96.24 vs 94.36; p< 0.0001) and variation of oxygen saturation was greater (17.63 vs 68.79; p< 0.0001) after unit transfer. These differences persisted when controlling for acute events and medication/ventilator changes. There were also significant changes in heart rate (143.71 vs 141.72; p=0.0011). Nebulizer usage and ventilator changes increased and sedation weaning slowed after transfer.Conclusion(s): In children with chronic ventilator dependence, there were significant population differences in charted vital signs in the 24 hours after unit transfer. These changes persist even when controlling for changes in care delivery suggesting that there may be differences in charting practice between units. Additional research is needed to further elucidate whether these differences are the results of true clinical change and whether they drive changes in practice.
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