383 - Critical Care Continuity (C3) Team: A Feasibility Study for a Pediatric Critical Care Outreach Team

Poster Number: 383
Publication Number: 383.243

Grace E. Logan, Children's Hospital Colorado, Denver, CO, United States; Hannah Friedman, University of Colorado School of Medicine, Department of Pediatrics, Denver, CO, United States; Tiffany D. McCombs, Children's Hospital Colorado, Denver, CO, United States; Carleen Schneiter, University of Colorado School of Medicine, Golden, CO, United States; Lauren Rutkowski, University of Colorado School of Medicine, Denver, CO, United States; Justin M. Lockwood, University of Colorado School of Medicine, Aurora, CO, United States

Background: At our institution, we identified a pattern of poor patient and family experience during transfer from the pediatric intensive care unit (PICU) to acute care units. Critical care outreach teams can improve experience, safety, and collaboration between intensive care and acute care floors.

Objective: To assess the feasibility, acceptability, and appropriateness of a Critical Care Continuity team (C3) to a diverse group of multidisciplinary stakeholders.

Design/Methods: We performed a 6-month Hybrid Type 3 pilot study of the C3 team (Figure 1), evaluating its feasibility, acceptability, and appropriateness (March to September 2021). We performed pre/post surveys of all nurses and providers representing relevant acute and critical care units. The instrument used was developed from the validated Acceptability of Intervention Measure (AIM), Intervention Appropriateness Measure (IAM), & Feasibility of Intervention Measure (FIM) tool. We ensured response process validity with cognitive interviews (the think-aloud technique). We distributed the survey in February 2021 and October 2021. We evaluated response data using chi-square tests. We performed C3 staff interviews to explore intervention barriers. Using chi-square and Mann-Whitney U tests, we compared proportion of PICU readmissions, Rapid Response Team activations, and Critical Deterioration Events between the pilot period and a baseline period, which included all eligible patients in the 12-months prior to the pilot.

Results: Of 74 eligible encounters, 45 (61%) received a C3 consult. We observed a 42% (76/178) and 43% (77/178) response rate for our pre- and post-surveys. We did not observe a difference between AIM/IAM/FIM measures pre/post, and stakeholders perceived C3 as feasible, acceptable, and appropriate (Table 1). Team member interviews revealed barriers including timely patient identification, proximity of transfer to hospital discharge, and C3 team member availability. Table 2 shows our comparison of clinical variables between pilot and baseline periods. We did not observe any differences in deterioration outcomes. Conclusion(s): Multidisciplinary stakeholders identified C3 as feasible, acceptable, and appropriate. This perception did not change after our 6-month pilot. We lacked statistical power to demonstrate associations with patient outcomes in this preliminary analysis. We plan to expand our pilot to additional hospital services guided by our findings and—with added enrollment—evaluate associations between C3 and outcomes, including patient & family experience, PICU readmission, deterioration events and patient flow.
Figure 1. Structure and function of the Critical Care Continuity (C3) team and consult process.i. Pilot eligibility criteria chosen at kick-off stakeholder focus groups based on anticipated clinical impact and convenience sampling,
ii. High-risk spinal fusion patients are defined at our institution based on underlying co-morbidities and potential risk of complications, including: 1) neuromuscular scoliosis and/or other spinal deformity with underlying chronic conditions; 2) idiopathic scoliosis with co-morbidities OR high degree of curvature, 3) undergoing major spinal or chest wall deformity procedure; a patient is determined to meet high-risk spinal fusion criteria at a pre-procedure clinic visit.
Table 1. Results from the C3 pilot program survey of hospital providers and nursing staff to assess feasibility, acceptability and appropriateness of the interventioni. C3 personnel include PICU advanced practice providers and critical care resource nurses,
ii. Abbreviations: C3 (Critical Care Continuity Team),
iii. All data presented as n (%).