PURPOSE: A change in our children’s hospital coverage model to providing full-time in-house supervision by intensivists allowed us to evaluate the impact of this change on patient safety outcomes. Our aim was to determine whether in-house attending coverage influenced the incidence and outcomes of pediatric code events.
METHODS: We conducted a retrospective review of all code events between October 2005 - October 2007 (pre in-house intensivist supervision) and compared the incidence, interventions, and outcomes of these codes to those occurring between April 2008 - April 2010 (post in-house intensivist supervision). A code event was defined as any activation of the code system.
RESULTS: On the ward, pre in-house intensivist supervision, there were 0.20 codes/1000 patient-days. Post in-house intensivist supervision, there was a significant increase in the rate of codes (0.71 codes/1000 patient-days; p=0.013) and an intensivist was significantly more likely to be present during these events (OR 28; 95% CI 3-273; p=0.001). Additionally, post in-house intensivist supervision, there were no differences in the illness severity scores of the patients involved, but there were significantly lower incidences of CPR, intubation, and atropine use for bradycardia, as well as a lower incidence of staff concerns about patient care on post-code review. In the codes occurring in the ICU, there were no significant differences in the rates of codes between the two periods (3.8 codes/1000 patient-days vs. 3.4 codes/1000 patient-days; p=0.73), but an intensivist was more likely to be present in the period post in-house intensivist supervision. There were no significant differences in patient illness severity, types and incidence of interventions, or in staff concerns on post-code review between the periods.
CONCLUSIONS: In the period following implementation of in-house intensivist supervision, there was a higher rate of codes, however, despite similar illness severity scores of the patients involved, these codes were associated with less interventions and less staff concerns about patient care on post-code review.
CLINICAL IMPLICATIONS: In-house intensivist coverage may prevent deterioration during codes that result in the need for interventions, thereby potentially improving outcomes.
DISCLOSURE: The following authors have nothing to disclose: Christopher Carroll, Kathleen Sala, Aaron Zucker, Fisher Daniel, Robert Englander
No Product/Research Disclosure Information