A PICU APP-Driven Quality Improvement Initiative to Improve Management of Escalation of Care Calls

Introduction: Escalation of care (rapid response team and PICU Consult) activation should occur when a patient demonstrates early signs of deterioration. Recently, the pediatric platform has experienced an increased number of preventable adverse events related to escalation of care activation. It was identified that our PICU APP’s sought more standardized education regarding responding to these calls. We developed an APP curriculum of low fidelity simulations to standardize the education provided with smart aim to improve comfort of responding to escalation of care calls by 20% by summer 2025. In review of literature, there was a paucity of published data for this education method.


Methods: In this quality improvement initiative, we implemented multidisciplinary low fidelity simulations with pre and post participation surveys. Our outcome measure is the delta between the pre and post survey responses. Our process measure we are following is APP and nursing participation percentage. Our balancing measure was related to perceived loss of time for clinical care by participating RN’s and APP’s.


Results: We completed a total of 6 low fidelity simulations and had 50% of APP and 12% of RN’s, and 37.5% orientees in participation. APP comfort increased by 60 %. Nursing comfort increased by 15%. There was no perceived decrease in time for clinical care while participating.


Conclusions: We demonstrated feasibility of using a low resources, short participation timeframe simulation curriculum to improve comfort for responding to escalation of care calls for PICU APPs. We hope to next create simulations for other patient populations we commonly care for.