A focused approach to patient care in the pediatric intensive care unit (PICU) at Children’s Hospital Colorado has led to a nearly 50% reduction in hospital-acquired conditions (HACs), according to a study published in Critical Care Nurse on .
The study details the implementation of weekly “high-risk rounds” – a process where an interprofessional team focuses on critically ill children identified as being at the greatest risk for developing HACs. These conditions, which include central line-associated bloodstream infections, catheter-associated urinary tract infections, unplanned extubation and pressure injuries, represent significant threats to patient safety and can prolong hospital stays.
Prior to implementing the high-risk rounding process, the hospital utilized standard HAC prevention measures, including auditing bedside nursing staff for adherence to established protocols and conducting root cause analyses following HAC events. The new approach, however, shifted the focus to proactive identification and mitigation of risk factors.
Identifying and Addressing Risk Factors
The interprofessional team developed specific criteria to identify patients at high risk for HACs. These criteria included factors such as the use of extracorporeal membrane oxygenation (ECMO), continuous renal replacement therapy (CRRT), or endotracheal intubation. Once identified, these patients were included in the high-risk rounds.
During the rounds, the team utilized a standardized script, developed using a Research Electronic Data Capture (REDCap) survey, to guide discussions and ensure comprehensive assessment of potential risks. This script prompted the team to address key elements related to HAC prevention and facilitated the collection of data to track progress.
“Our high-risk rounds focus on the underlying risks for multiple HACs and extend prevention efforts ‘beyond the bundle,’ in a collaborative and supportive way,” explained Dr. Michele Loi, PICU director of quality and faculty physician at Children’s Hospital Colorado, and an associate professor of pediatrics at University of Colorado School of Medicine. “The approach can be easily adapted for changes in patient population and different clinical needs.”
Significant Reduction in HAC Rates
Over a two-year period, from to , the team conducted 624 rounds for 488 unique patients. This resulted in 351 interventions, ranging from escalating concerns to providing direct patient care, procuring necessary resources, and delivering targeted education.
The data revealed a significant decrease in the mean rate of project-specific HACs, falling from 5.41 events per 1,000 patient days to 2.89 events per 1,000 patient days. This represents a 46.5% reduction in HAC rates, which was sustained throughout the two-year project period. The 48-bed PICU at Children’s Hospital Colorado serves approximately 3,500 admissions annually from across seven states.
Based on these findings, the researchers estimate that the high-risk rounding process prevented approximately 50 HACs during the study period. This not only improved patient safety but also generated significant cost savings for the hospital.
Beyond Prevention: Identifying Systemic Improvements
The high-risk rounds proved to be more than just a preventative measure; they also served as a valuable tool for identifying trends and opportunities for improvement within the PICU. The process revealed practice gaps and prompted further investigation into areas such as unit psychological safety, PICU policies, and the shift safety-check process.
The success of this initiative highlights the importance of a proactive, interprofessional approach to HAC prevention in the PICU setting. By focusing on the underlying risks and fostering a collaborative environment, hospitals can significantly reduce the incidence of these potentially devastating complications and improve outcomes for their youngest and most vulnerable patients.
Patients who participated in high-risk rounds were significantly less likely to experience a HAC compared to those who did not. This underscores the value of targeted interventions and proactive risk assessment in improving patient safety.
Sara Galt et al, Reducing Hospital-Acquired Conditions in the Pediatric Intensive Care Unit With a High-Risk Rounding Process, Critical Care Nurse (2026). DOI: 10.4037/ccn2026558
