1334: A Step Ahead: Detailing the Scope and Outcomes of a Pediatric Nurse-Driven Proactive Rounding Team

Introduction: Timely recognition of clinical deterioration events (CDEs) improves pediatric outcomes. While rapid response teams (RRTs) reduce ICU transfers and cardiac arrests, most models are reactive and physician led. Few studies describe proactive RRT rounding, and fewer highlight nurse-led approaches that can be integrated into daily workflow. In settings with limited resources, a nurse-driven model may offer a scalable, cost-effective strategy to identify at-risk patients, deliver early interventions, educate staff, and improve safety culture. Our institution implemented a nurse-led proactive rounding program aiming to reduce CDEs. We describe its role in early assessment, escalation, communication, and staff support. Methods: We conducted a retrospective review of pediatric RRT activations from April 2024 to May 2025. Data sources included electronic health records, RRT logs, proactive rounding lists, and hospital census reports. Pre-implementation data (April–August 2024) served as baseline. We analyzed rounding triggers, nurse-led interventions, ICU transfers, and CDEs. RRT nurses were surveyed regarding frequent interventions and common RRT activation causes. Results: Proactive rounding was most often triggered by bedside nursing concern (38%), elevated PEWS (18%), or prior RRT follow-up (16%). The most frequent intervention was bedside education/support (54%) followed by facilitating discussions with primary teams (10%); 25% required no intervention. RRT nurses reported helping with assessments, recommending therapies, and initiating rapid responses as most of their bedside support. Of those needing a rapid response, those with a prior proactive round had a 12% rate of ICU transfer (20/162) compared to 59% of those without a proactive round (92/157). Both groups had similar CDE rates (15% vs 13%). However, 74% of patients requiring a rapid response did not receive proactive rounding (174/234), indicating missed proactive rounding opportunities. Conclusions: We describe a nurse-led proactive rounding program as a feasible strategy to reduce ICU transfers and support bedside care. Empowering critical care nurses as autonomous responders may enhance surveillance and optimize resource use. However, further data is needed to improve identification of high-risk patients and increase rounding coverage.