119 - Building a Culture of Psychological Safety in the Cath Lab Using Pedi-PAUSE

Description: As patient acuity and severity of illness in the congenital heart population have increased, so too has the complexity of interventional procedures performed in the cardiac catheterization lab. In this highly specialized environment, effective team collaboration, clear communication, and psychological safety are critical to ensuring safe and high-quality patient outcomes.
The post-pandemic nursing workforce has introduced new challenges, particularly in recruiting experienced staff. The department staffing demographics includes a mean of 3.5 years of nursing and a mean of 2.5 years of cardiovascular technologist experience in pediatric congenital cardiac catheterization. Limited clinical experience within the nursing workforce has affected overall team confidence, presenting challenges to fostering a strong culture of safety in this high-stress, high-acuity environment.
Recognizing these challenges, the clinical nursing team identified the need to move beyond the traditional procedural time-out and implement a more intentional, structured approach to pre-procedural preparation. This led to the development and implementation of a standardized pre-procedural huddle and secondary pause prior to intervention. The Pedi-PAUSE initiative, led by the nursing team, was created specifically to address these gaps. This process was designed to promote psychological safety, improve interdisciplinary communication, clarify team roles, and enhance procedural readiness. In collaboration with cardiovascular technologists, interventional cardiologists, and the chief of anesthesia, the nursing team led the development of a structured tool that incorporates patient risk stratification, a comprehensive procedure preparation checklist, a secondary interventional timeout, and a post-procedure debrief prompt to assess team members perceived psychological safety.
Following the implementation of the Pedi-PAUSE tool, the unit-based Shared Governance Council assumed responsibility for monitoring staff compliance and tool utilization. Over a four-month period, adherence to the Pedi-PAUSE process improved significantly, increasing from an initial 0% to 83% utilization. Prior to implementation, a baseline staff survey, with 100% participation, revealed that 33% of team members did not feel adequately prepared to safely manage interventional catheterization procedures, directly impacting their sense of psychological safety. Post-implementation data collection and analysis remain ongoing; however, preliminary findings over the past several months indicate a marked improvement. Staff reported feeling adequately prepared and supported in 98.3% of high-risk cases in which the Pedi-PAUSE was utilized. These early outcomes suggest that the structured huddle process has positively influenced team readiness, confidence, and perceived psychological safety in the procedural environment.