Luregn Schlapbach, Professor and PICU/Neonatology lead focused on ICU quality and outcomes. Janet Kelly-Geyer, senior PICU consultant skilled in team-based safety improvements. They describe the ABC-PRO handover tool and its Plan, Risk, Options add-on. Conversation covers implementation, training, documentation, study design, and reported reductions in PICU cardiac arrests and mortality.
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insights INSIGHT
Handover Should Forecast Next 12 Hours
ICU handovers must shift from historical reporting to proactive forecasting of the next 12 hours.
Dr Luregn Schlapbach observed sentinel events where risks discussed earlier were lost, prompting a focus on anticipating patient trajectories.
volunteer_activism ADVICE
Use ABC PRO To Empower Team Speaking Up
Encourage multidisciplinary participation and flatten hierarchy during handover so nurses and juniors can speak up.
At Zurich the resident formulates ABC-PRO and all present can challenge risk or plan, fostering shared mental model.
volunteer_activism ADVICE
Add PRO To ABC For Actionable Handover
Use a structured add-on to ABC that specifies Plan, Risk (color coded), and Options at bedside each handover.
The resident, nurses, and consultant jointly state the 12-hour plan, list specific risks, and predefine management options.
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In this World Shared Practice Forum Podcast, Drs. Luregn Schlapbach and Janet Kelly-Geyer discuss the implementation and impact of the Airway, Breathing, Circulation - Plan, Risk, Options (ABC-PRO) handover tool in the Pediatric Intensive Care Unit. They discuss how a structured, proactive risk assessment during clinical handovers can reduce cardiac arrest rates and improve patient outcomes. They share perspectives on enhancing team situational awareness by anticipating high-risk events, identifying management strategies, and encouraging multidisciplinary participation in anticipatory care. Lastly, they highlight how the ABC-PRO framework advances overall patient safety in critical care settings.
LEARNING OBJECTIVES
- Understand the ABC-PRO tool’s function in reducing cardiac arrests and enhancing safety
- Examine bedside team-based discussions around key patient risks during handovers using the ABC-PRO tool
- Recognize the significance of interdisciplinary collaboration in patient management
- Assess the potential for implementing similar handover improvements in diverse healthcare settings
AUTHORS
Luregn Schlapbach, MD, PhD
Professor in Pediatric Intensive Care,
Head of Department of Intensive Care and Neonatology,
University Children`s Hospital Zurich
Janet Kelly-Geyer, MBChB
Senior PICU Consultant
University Children's Hospital Zurich
Jeffrey Burns, MD, MPH
Emeritus Chief
Division of Critical Care Medicine
Department of Anesthesiology, Critical Care and Pain Medicine
Boston Children's Hospital
Professor of Anesthesia
Harvard Medical School
DATE
Initial publication date: March 24, 2026.
ARTICLES REFERENCED
- Catchpole KR, de Leval MR, McEwan A, et al. Patient handover from surgery to intensive care: using Formula 1 pit-stop and aviation models to improve safety and quality. Paediatr Anaesth. 2007;17(5):470-478. doi:10.1111/j.1460-9592.2006.02239.x
- Starmer AJ, Spector ND, Srivastava R, et al. Changes in medical errors after implementation of a handoff program. N Engl J Med. 2014;371(19):1803-1812. doi:10.1056/NEJMsa1405556
- Riley CM, Diddle JW, Harlow A, et al. Shifting the Paradigm: A Quality Improvement Approach to Proactive Cardiac Arrest Reduction in the Pediatric Cardiac Intensive Care Unit. Pediatr Qual Saf. 2022;7(1):e525. Published 2022 Jan 21. doi:10.1097/pq9.0000000000000525
- Spaeder MC, Lee L, Miller C, Keim-Malpass J, Harmon WG, Kausch SL. Incidence of cardiac arrest following implementation of a predictive analytics display in a pediatric intensive care unit. Resusc Plus. 2025;21:100862. Published 2025 Jan 2. doi:10.1016/j.resplu.2024.100862
TRANSCRIPT
https://cdn.bfldr.com/D6LGWP8S/at/f7xr7vcxc6f4mhc9736tzpb/202603_WSP_Schlapbach___Kelly-Geyer_Transcript.pdf
Please visit: http://www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children’s Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open-access thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu
CITATION
Schlapbach LJ, Kelly-Geyer JF, Burns JP. Reducing Cardiac Arrests in the PICU with ABC-PRO. 03/2026. OPENPediatrics. Online Podcast.