144 - Safety Officer: Implementation Of Bedside Hospitalist Support Of Safety Practices On A Pediatric Surgical Unit

Poster Number: 144
Publication Number: 144.1614

Background: Review of safety events on our surgical inpatient unit in 2020 revealed opportunities to improve care team communication, shared situational awareness, and care escalation for deteriorating patients. Action items from root cause analyses led to the creation of a hospitalist surgical co-management team in Fall 2022 to improve care for patients with medical complexity post-operatively. A proposed responsibility of the team included a hospitalist functioning as the surgical unit’s Safety Officer (SO), a novel intervention to support patients and staff through rapid response team (RRT) participation and safety practice promotion.

Objective: To evaluate SO implementation including assessment of acceptability, appropriateness, and feasibility

Design/Methods: We applied the RE-AIM (Reach, Effectiveness, Adoption, Implementation, & Maintenance) framework to evaluate SO implementation. We provided SO training on institutional safety practices and RRT scripting to SO hospitalists. We administered REDCap experience surveys to bedside nurses, hospitalists, surgeons, and RRT personnel with questions adapted from the AIM, IAM, FIM (acceptability, appropriateness, feasibility) implementation tool. We collected clinical data on care escalations, including the validated Emergency Transfer measure, from EPIC reports. We analyzed survey data using chi square tests for proportions and clinical data using statistical process control charts with established special cause rules.

Results: The survey response rate was 27% (n=126): 24% were ICU providers (n=30), 40% hospitalist providers (n=50), 18% surgical providers (n=23), and 18% nurses (n=23). Results were organized by the RE-AIM domains (Table 1). Most respondents had engaged with the SO clinically at least once (62%) and believed SO improved the unit’s safety culture (56%). Nurses reported SO improved their ability to effectively escalate care (94%). RRTs with SO involvement increased from zero to 78% post implementation (47/60), and respondents reported high SO acceptability, appropriateness, and feasibility (Table 2). Most non-SO providers did not believe SO detracted from ownership of their patients (97%) and SO hospitalists felt they could effectively balance competing responsibilities (92%).

Conclusion(s): We successfully implemented SO on the surgical inpatient unit and stakeholders perceived high SO acceptability, appropriateness, and feasibility. SOs reliably completed their primary task of RRT participation. We improved perceived unit safety culture, especially among nurses. Next steps include evaluation of SO effectiveness at improving patient outcomes.