Kathleen W Bartlett1,2, Victoria M Parente2, Vanessa Morales3, Jillian Hauser3, Heather S McLean4,2. 1. Division of Pediatric Hospital and Emergency Medicine, and katy.bartlett@duke.edu. 2. Department of Pediatrics, Duke Children's Hospital, and. 3. Performance Services, Duke University Health System, Durham, North Carolina. 4. Division of Pediatric Hospital and Emergency Medicine, and.
Abstract
BACKGROUND: Asthma exacerbations are a leading cause of hospitalization among children. Despite the existence of national pediatric asthma guidelines, significant variation in care persists. At Duke Children's Hospital, we determined that our average length of stay (ALOS) and cost for pediatric asthma admissions exceeded that of our peers. Our aim was to reduce the ALOS of pediatric patients hospitalized with asthma from 2.9 days to 2.6 days within 12 months by implementing an asthma pathway within our new electronic health record. METHODS: We convened a multidisciplinary committee charged with reducing variability in practice, ALOS, and cost of inpatient pediatric asthma care, while adhering to evidence-based guidelines. Interventions were tested through multiple "plan-do-study-act" cycles. Control charts of the ALOS were constructed and annotated with interventions, including testing of an asthma score, implementation of order sets, use of a respiratory therapy-driven albuterol treatment protocol, and provision of targeted education. Order set usage was audited as a process measure. Readmission rates were monitored as a balancing measure. RESULTS: The ALOS of pediatric patients hospitalized with asthma decreased significantly from 2.9 days to 2.3 days. Comparing baseline with intervention variable direct cost data revealed a savings of $1543 per case. Improvements occurred in the context of high compliance with the asthma pathway order sets. Readmission rates remained stable throughout the study period. CONCLUSIONS: Implementation of an asthma care pathway based on the electronic health record improved the efficiency and variable direct costs of hospital care, reduced variability in practice, and ensured adherence to high-quality national guidelines.
BACKGROUND: Asthma exacerbations are a leading cause of hospitalization among children. Despite the existence of national pediatric asthma guidelines, significant variation in care persists. At Duke Children's Hospital, we determined that our average length of stay (ALOS) and cost for pediatric asthma admissions exceeded that of our peers. Our aim was to reduce the ALOS of pediatric patients hospitalized with asthma from 2.9 days to 2.6 days within 12 months by implementing an asthma pathway within our new electronic health record. METHODS: We convened a multidisciplinary committee charged with reducing variability in practice, ALOS, and cost of inpatient pediatric asthma care, while adhering to evidence-based guidelines. Interventions were tested through multiple "plan-do-study-act" cycles. Control charts of the ALOS were constructed and annotated with interventions, including testing of an asthma score, implementation of order sets, use of a respiratory therapy-driven albuterol treatment protocol, and provision of targeted education. Order set usage was audited as a process measure. Readmission rates were monitored as a balancing measure. RESULTS: The ALOS of pediatric patients hospitalized with asthma decreased significantly from 2.9 days to 2.3 days. Comparing baseline with intervention variable direct cost data revealed a savings of $1543 per case. Improvements occurred in the context of high compliance with the asthma pathway order sets. Readmission rates remained stable throughout the study period. CONCLUSIONS: Implementation of an asthma care pathway based on the electronic health record improved the efficiency and variable direct costs of hospital care, reduced variability in practice, and ensured adherence to high-quality national guidelines.
Authors: Andrew G Miller; Kaitlyn E Haynes; Rachel M Gates; Kanecia O Zimmerman; Travis S Heath; Kathleen W Bartlett; Heather S McLean; Kyle J Rehder Journal: Respir Care Date: 2019-05-14 Impact factor: 2.258
Authors: Teresa G Magruder; Sridaran Narayanan; Susan Walley; Tony Powers; Hollace Whitlock; Kathleen Harrington; Terry C Wall Journal: Pediatr Qual Saf Date: 2017-08-22
Authors: Rogers Ayiko; Paschal N Mujasi; Joyce Abaliwano; Dickson Turyareeba; Rogers Enyaku; Robert Anguyo; Walter Odoch; Pauline Bakibinga; Tom Aliti Journal: BMC Health Serv Res Date: 2020-10-06 Impact factor: 2.655