Amy E Lawrence1, Justin T Huntington2, Kate Savoie1, Michael Dykes3, Jennifer H Aldrink1, Holden Richards4, Gail E Besner1, Brian Kenney1, Jeremy Fisher1, Peter C Minneci1, Marc P Michalsky5. 1. Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH. 2. Department of Pediatric Surgery, Akron Children's Hospital, Akron, OH. 3. Department of Quality Improvement Services, Nationwide Children's Hospital, Columbus, OH. 4. Oregon Health and Science University School of Medicine, Portland, OR. 5. Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH. Electronic address: Marc.Michalsky@nationwidechildrens.org.
Abstract
PURPOSE: The objective of this quality improvement (QI) initiative was to implement a standardized clinical treatment protocol for patients presenting with primary spontaneous pneumothorax (PSP) in order to decrease hospital length of stay (LOS), diagnostic radiation exposure, and related cost. METHODS: Baseline data from patients admitted with PSP from January 1, 2016 to July 31, 2018 were compared to data from patients managed using a newly developed evidence-based treatment pathway from August 1, 2018 to December 31, 2019. Standard QI methodology was used to track results. RESULTS: Fifty-six episodes of PSP were observed during the baseline period and 40 episodes of PSP following initiation of the PSP protocol. The average LOS decreased from 4.5 days to 2.9 days. Patients underwent an average of 8.8 X-rays per admission preintervention versus 5.9 postintervention. The rate of CT scans decreased from 45% to 15% (p = 0.002). There was no significant difference in the rates of 30-day recurrence between the preintervention (13%) and postintervention (10%) groups (p = 0.7). Average admission costs per patient decreased by $1322 after adoption of the pathway. CONCLUSIONS: Adoption of a standardized treatment protocol for PSP led to a reduction in LOS, diagnostic imaging utilization, and cost without increasing clinical recurrence. TYPE OF STUDY: Quality improvement. LEVEL OF EVIDENCE: Level III.
PURPOSE: The objective of this quality improvement (QI) initiative was to implement a standardized clinical treatment protocol for patients presenting with primary spontaneous pneumothorax (PSP) in order to decrease hospital length of stay (LOS), diagnostic radiation exposure, and related cost. METHODS: Baseline data from patients admitted with PSP from January 1, 2016 to July 31, 2018 were compared to data from patients managed using a newly developed evidence-based treatment pathway from August 1, 2018 to December 31, 2019. Standard QI methodology was used to track results. RESULTS: Fifty-six episodes of PSP were observed during the baseline period and 40 episodes of PSP following initiation of the PSP protocol. The average LOS decreased from 4.5 days to 2.9 days. Patients underwent an average of 8.8 X-rays per admission preintervention versus 5.9 postintervention. The rate of CT scans decreased from 45% to 15% (p = 0.002). There was no significant difference in the rates of 30-day recurrence between the preintervention (13%) and postintervention (10%) groups (p = 0.7). Average admission costs per patient decreased by $1322 after adoption of the pathway. CONCLUSIONS: Adoption of a standardized treatment protocol for PSP led to a reduction in LOS, diagnostic imaging utilization, and cost without increasing clinical recurrence. TYPE OF STUDY: Quality improvement. LEVEL OF EVIDENCE: Level III.