TOP 20 - Implementation of structured nurse-led night rounds to improve clinical communication efficiency and efficacy in a pediatric intensive care unit: A quality improvement initiative

Publication Number: 3749.TOP 20

Shekinah J. Vaughn, University of Texas Southwestern Medical School, Dallas, TX, United States; Megan L. Shea, University of Texas Southwestern Medical School, Dallas, TX, United States; Chasity Custer, University of Texas Southwestern Medical School, Dallas, TX, United States; Kendel P. Richards, Children's, Argyle, TX, United States; Emily Ressman, The University of Texas Health Science Center at San Antonio Joe R. and Teresa Lozano Long School of Medicine, Dallas, TX, United States; Olivia L. Hoffman, University of Texas Southwestern Medical School, Dallas, TX, United States; Carter A. Crain, University of Texas Southwestern Medical School, Dallas, TX, United States

Background: Effective communication among healthcare teams is essential to high quality care, yet communication failures remain a major cause of sentinel events. Multidisciplinary collaborative rounds improve outcomes, standardize practices, and enhance communication. However, consistent implementation is challenging. Nursing engagement is a key barrier, and structured nursing-led rounding tools show promise to drive standardization for reliable and high-quality care.

Objective: We aim to implement a structured, nurse-led rounding tool to standardize night rounds in our Pediatric Intensive Care Unit (PICU). This intervention seeks to improve identification of patients at risk for cardiopulmonary decompensation and increase consistency in discussions of neurological status, particularly State Behavioral Scale (SBS) goals. Guided by our SMART aim, by January of 2027, we plan to improve identification of at-risk patients from 0% to 80%, increase consistent discussion of sedation goals from 43% to 80%, and improve team satisfaction, as measured by a Likert-scale survey. Rounding duration will be monitored as a balancing measure, with a target of no more than a 20% increase from baseline of 38 minutes per team.

Design/Methods: In collaboration with multidisciplinary stakeholders and using standard quality improvement methods with 6-8 week Plan-Do-Study-Act (PDSA) cycles we will implement a standardized, nurse-led nighttime rounding tool in our 44-bed medical and surgical PICU. Process, outcome and balancing measures will be collected. Data will be obtained primarily through direct observation of rounds and team satisfaction surveys to assess perceptions of the new rounding process. This data will be used to track and analyze trends in the identification of patients at risk for clinical decompensation, how teams are making and meeting their clinical goals, and the total duration of rounds over the course of implementation. The project launched in September 2025 and will have first three PDSA cycles analyzed by end of January 2026. This project was deemed IRB exempt.

Communication of Patient care on Night Round in the PICU
Baseline data on things discussed on nighttime rounds prior to intervention