Late Rescue Collaborative: Reducing Non-ICU Arrests*

Objective: To reduce the frequency of non-ICU arrests through the implementation of an intramural collaborative focused on patient deterioration. Design: Prospective quality improvement project. Setting: Single-center, free-standing, tertiary children's hospital. Patients: All patients admitted to acute care units. Interventions: The Late Rescue Collaborative was formed in 2014 to monitor compliance with hospital escalation protocols and evaluate episodes of patient deterioration. The collaborative is a multidisciplinary team of physicians, nurses, and respiratory care providers. Three monthly meetings occur: 1) individual acute care unit-based meetings to evaluate trends and performance; 2) hospital-wide multidisciplinary whole group meetings to review hospital trends in deterioration and share lessons learned; and 3) steering committee to determine areas of focus. Based on these three meetings, unit-and hospital-based interventions have been put in place to improve recognition of deterioration and promote early rescue. Measurements and Main Results: Rates of rapid response team activations, unplanned transfers, and non-ICU arrest are reported. Non-ICU arrest rates fell from a baseline of 0.31 per 1,000 non-ICU patient days to a new centerline of 0.11 and sustained for 36 months. Days between non-ICU arrests increased from a baseline of 15.5 days in year 2014 to a new centerline of 61.5 days and sustained for 37 months. Mortality following non-ICU arrests fell from four in 2014 and 2015 to zero in years 2016-2018. Conclusion: The Late Rescue Collaborative is an effective tool to improve patient safety by reducing non-ICU arrests.