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Research Snapshot Theater: Research, Pediatric II

Developing an EHR-Embedded Digital Safety Net to Reduce Acute Care Critical Deterioration Events

Sunday, March 22, 2026
11:00 AM - 12:00 PM Central Time
Location: Connections Central - RST 18
  • WT

    Warren Michael Taylor, MD, MPH

    Golisano Children's Hospital

    Disclosure(s): No relevant financial relationship(s) to disclose.

  • GB

    Gabriella Butler, MSN, RN

    Director of Healthcare Analytics and Strategy
    UPMC Children's Hospital of Pittsburgh

    Disclosure information not submitted.

  • HH

    Harry Hochheiser, PhD

    Associate Professor
    University of Pittsburgh Department of Biomedical Informatics

    Disclosure information not submitted.

  • AM

    Adrienne Marcinick, RN

    Senior System Analyst
    UPMC Children's Hospital of Pittsburgh Health Informatics Division

    Disclosure information not submitted.

  • CP

    Celia Pulver, RN, BSISM

    Systems Analyst, Expert
    UPMC Children's Hospital of Pittsburgh

    Disclosure information not submitted.

  • HW

    Holly Warmus, MSN, RN, CPN

    Nursing Unit Director
    UPMC Children's Hospital of Pittsburgh

    Disclosure information not submitted.

  • SC

    Stacey Cote, MSN, RN, CPN

    Manager -Clinical Transplant Services, Hepatology & Intestinal Care
    UPMC Children's Hospital of Pittsburgh

    Disclosure information not submitted.

  • SH

    Sheila Hahner, MSN,RN

    Advanced Clinical Education Specialist
    UPMC Children's Hospital of Pittsburgh

    Disclosure information not submitted.

  • SS

    Srinivasan Suresh, MD, MBA, FAAP

    Vice President and Chief Information Officer
    UPMC Children's Hospital of Pittsburgh

    Disclosure information not submitted.

  • JR

    Johanna Rosen, MD

    Asst Director of Clinical Affairs, Pediatric Emergency Medicine Data, Quality and Improvement Sci
    UPMC Children's Hospital of Pittsburgh

    Disclosure information not submitted.

  • KB

    Kelly Bricker, BSN, CPHIMS, RN

    Clinical Informatics Nurse
    UPMC Children's Hospital of Pittsburgh

    Disclosure information not submitted.

  • RC

    Robert Clark, MD

    Professor of Pediatric Critical Care Medicine, Endowed Chair of Pediatric Critical Care Medicine
    Department of Critical Care Medicine, Safar Center for Resuscitation Research, John G. Rangos Research Center, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA 15224, USA

    Disclosure information not submitted.

  • PK

    Patrick Kochanek, MD, MCCM

    Director of the Safar Center for Resuscitation Research
    Department of Critical Care Medicine, Safar Center for Resuscitation Research, John G. Rangos Research Center, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA 15224, USA

    Disclosure information not submitted.

  • JC

    Joseph Carcillo, MD

    Clinician
    Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center

    Disclosure information not submitted.

  • CH

    Christopher Horvat, MD, MHA

    University of Pittsburgh, Pennsylvania

    Disclosure information not submitted.

Introduction: Children on acute care floors face risk of critical deterioration, including cardiac arrest, urgent ICU transfer, and death. These events add approximately $100,000 of costs per admission, prolong ICU stays, and increase in-hospital mortality. We hypothesized that the deployment of an EHR-embedded deterioration prediction model would reduce critical deterioration in pediatric acute care at our quaternary children’s hospital.


Methods: Between 2017 and 2018, acute care units adopted a two-level sepsis screening process: a rule-based EHR trigger, followed by a bedside huddle and sepsis order set activation. Building on this, a deterioration prediction score was developed using 2017 admissions data. The random forest model incorporated structured clinical variables and intuitive nurse assessments to predict a composite outcome of life-threatening deterioration events, including cardiac arrest, urgent ICU transfer, or death. The model was embedded into the EHR, with iterative Plan-Do-Study-Act cycles used to refine both predictive accuracy and workflow integration over time. An interrupted time series analysis evaluated the sequential interventions impact on deterioration rates, rapid response activations, and mortality. AI tools assisted with code editing but not content creation or analysis.


Results: The 313-bed hospital (181 acute care beds) recorded 143,808 acute care admissions and 318,678 patient days from Jan 2018–Dec 2024. Implementation of sepsis and shock screening was associated with a decline in critical deterioration from 2.5 per 10,000 admissions in 2018 to 0.2 per 10,000 between 2019–2022 (P < 0.001). Mortality among patients transferred to the ICU fell 31%. Following deterioration model integration in Sept 2022, the rapid response activation rate fell by 0.51 events per 10,000 patient days each month post-implementation (P < 0.001). Overall, the rate of critical deterioration decreased from 150.2 per 10,000 patient days in 2022 to 110.4 per 10,000 patient days in 2024.


Conclusions: The development and deployment of a digital safety net was linked to a significant reduction in critical deterioration among acute care pediatric patients at our children’s hospital. Continued refinement of the model may further support clinicians in early recognition and timely resuscitation.