David P Johnson1, Donald H Arnold2,3, James C Gay4, Alison Grisso5, Michael G O'Connor6, Ellen O'Kelley3,6, Paul E Moore6. 1. Divisions of Hospital Medicine and david.p.johnson.1@vanderbilt.edu. 2. Division of Emergency Medicine. 3. Department of Pediatrics, School of Medicine, and. 4. General Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee. 5. Department of Pharmacy, Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tennessee. 6. Allergy, Immunology, and Pulmonary Medicine, and.
Abstract
BACKGROUND: Standardized pediatric asthma care has been shown to improve measures in specific hospital areas, but to our knowledge, the implementation of an asthma clinical practice guideline (CPG) has not been demonstrated to be associated with improved hospital-wide outcomes. We sought to implement and refine a pediatric asthma CPG to improve outcomes and throughput for the emergency department (ED), inpatient care, and the ICU. METHODS: An urban, quaternary-care children's hospital developed and implemented an evidence-based, pediatric asthma CPG to standardize care from ED arrival through discharge for all primary diagnosis asthma encounters for patients ≥2 years old without a complex chronic condition. Primary outcomes included ED and inpatient length of stay (LOS), percent ED encounters requiring admission, percent admissions requiring ICU care, and total charges. Balancing measures included the number of asthma discharges between all-cause 30-day readmissions after asthma discharges and asthma relapse within 72 hours. Statistical process control charts were used to monitor and analyze outcomes. RESULTS: Analyses included 3650 and 3467 encounters 2 years pre- and postimplementation, respectively. Postimplementation, reductions were seen in ED LOS for treat-and-release patients (3.9 hours vs 3.3 hours), hospital LOS (1.5 days vs 1.3 days), ED encounters requiring admission (23.5% vs 18.8%), admissions requiring ICU (23.0% vs 13.2%), and total charges ($4457 vs $3651). Guideline implementation was not associated with changes in balancing measures. CONCLUSIONS: The hospital-wide standardization of a pediatric asthma CPG across hospital units can safely reduce overall hospital resource intensity by reducing LOS, admissions, ICU services, and charges.
BACKGROUND: Standardized pediatric asthma care has been shown to improve measures in specific hospital areas, but to our knowledge, the implementation of an asthma clinical practice guideline (CPG) has not been demonstrated to be associated with improved hospital-wide outcomes. We sought to implement and refine a pediatric asthma CPG to improve outcomes and throughput for the emergency department (ED), inpatient care, and the ICU. METHODS: An urban, quaternary-care children's hospital developed and implemented an evidence-based, pediatric asthma CPG to standardize care from ED arrival through discharge for all primary diagnosis asthma encounters for patients ≥2 years old without a complex chronic condition. Primary outcomes included ED and inpatient length of stay (LOS), percent ED encounters requiring admission, percent admissions requiring ICU care, and total charges. Balancing measures included the number of asthma discharges between all-cause 30-day readmissions after asthma discharges and asthma relapse within 72 hours. Statistical process control charts were used to monitor and analyze outcomes. RESULTS: Analyses included 3650 and 3467 encounters 2 years pre- and postimplementation, respectively. Postimplementation, reductions were seen in ED LOS for treat-and-release patients (3.9 hours vs 3.3 hours), hospital LOS (1.5 days vs 1.3 days), ED encounters requiring admission (23.5% vs 18.8%), admissions requiring ICU (23.0% vs 13.2%), and total charges ($4457 vs $3651). Guideline implementation was not associated with changes in balancing measures. CONCLUSIONS: The hospital-wide standardization of a pediatric asthma CPG across hospital units can safely reduce overall hospital resource intensity by reducing LOS, admissions, ICU services, and charges.
Authors: Donald H Arnold; Wu Gong; James W Antoon; Leonard B Bacharier; Thomas G Stewart; David P Johnson; Wendell S Akers; Tina V Hartert Journal: J Allergy Clin Immunol Pract Date: 2021-12-13
Authors: Alex Aregbesola; Ahmed M Abou-Setta; Maya M Jeyaraman; George Okoli; Otto Lam; Kathryn M Sibley; Terry P Klassen Journal: Syst Rev Date: 2020-03-03
Authors: Xavier Sánchez; María Orrico; Toa Morillo; Andrea Manzano; Ruth Jimbo; Luciana Armijos Journal: PLoS One Date: 2021-04-01 Impact factor: 3.240
Authors: Alex Aregbesola; Ahmed M Abou-Setta; George N Okoli; Maya M Jeyaraman; Otto Lam; Viraj Kasireddy; Leslie Copstein; Nicole Askin; Kathryn M Sibley; Terry P Klassen Journal: PLoS One Date: 2021-03-24 Impact factor: 3.240