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Introduction: The Pediatric Acute Care Cardiology Collaborative (PAC3) was established in 2014 to understand systems and clinical practices in cardiac care delivered outside the intensive care unit with a focus on outcomes, quality improvement, and patient safety. An initial PAC3 project was a comprehensive survey to understand unit structure, practices, and resource utilization across the collaborative. Methods: The survey consisted of 126 stem questions. Many questions had branching logic for positive responses leading to 412 total possible response fields. Questions were categorized into domains: demographics, staffing, resources and therapies, and standard care practices. Five supplemental questions addressed patient and surgical volume variables. Responses were recorded and stored in a REDCap database. Results: Surveys were completed by 31 (91%) of 34 member centers. A majority (19, 61%) of centers have a single, dedicated cardiac acute care unit (ACU), which is contiguous or on the same floor as the ICU in 15 (48%). A nurse staffing ratio of 3:1 is employed in 71% of centers and 26 (84%) reported having a resource nurse. Centralized wireless rhythm monitoring is used in 26 (84%) centers with 14 (54%) staffed continuously. Table 1 shows the use of various high-acuity therapies. Figure 1 illustrates the varied use of protocols and procedures in this population. Conclusions: The PAC3 hospital survey is the most thorough effort to understand systems and clinical care practices in the cardiac ACU to date. It demonstrates notable heterogeneity and varied practice patterns amongst units. Further study may identify a combination of structure and services that can enhance efficiency, safety, and patient outcomes. [ABSTRACT FROM AUTHOR]

B Introduction: b Children dependent on long-term mechanical ventilation (LTMV) are typically admitted to a pediatric intensive care unit (PICU) from home or long-term acute (LTAC) facilities when hospitalized. B Conclusions: b Our data shows that the number of ventilator days per admission encounter and per individual patient were significantly different between the two groups irrespective of LTMV status. We surmise that patients discharged to a LTAC facility had longer ventilator days because they are more likely to have multiple comorbidities that impact their need for mechanical ventilation. [Extracted from the article]

B Learning Objectives: b Unplanned self-extubation remains a significant risk of morbidity in intubated children. A multi-modal process improvement intervention that increases awareness at high-risk periods, addresses contributing risk factors in high-risk patients and improves goal-directed sedation management can have substantial impact in reducing unplanned extubations. [Extracted from the article]