Improving the Efficiency of Care for Pediatric Patients Hospitalized With Asthma.

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2017-01

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Abstract

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.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.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.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.

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Published Version (Please cite this version)

10.1542/hpeds.2016-0108

Publication Info

Bartlett, Kathleen W, Victoria M Parente, Vanessa Morales, Jillian Hauser and Heather S McLean (2017). Improving the Efficiency of Care for Pediatric Patients Hospitalized With Asthma. Hospital pediatrics, 7(1). pp. 31–38. 10.1542/hpeds.2016-0108 Retrieved from https://hdl.handle.net/10161/20342.

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Scholars@Duke

Bartlett

Kathleen Wurth Bartlett

Professor of Pediatrics

Quality Improvement
Pediatric Medical Student and Residency Education
Leadership Development
Asthma Education
Pediatric Urinary Tract Infections

Parente

Victoria Marie Parente

Assistant Professor of Pediatrics

I am a pediatric hospitalist and health services researcher with a faculty appointment in the Department of Pediatrics, Division of Hospital Medicine. The aim of my research is to reduce health inequities in the pediatric hospital setting.  Currently, my main projects are around improving racial and ethnic differences in medical team communication and caregiver (parent/guardian) empowerment on family-centered rounds.  Additional projects include addressing inpatient caregiver food insecurity, minimizing biased language in patient handoffs, and improving language access for families that use a language other than English in healthcare settings.

McLean

Heather Seabury McLean

Professor of Pediatrics

My interests include quality improvement and patient safety, patient-family centered care, pediatric hospital medicine, and graduate and undergraduate medical education.  Through system change, I aim to improve the quality, value and safety of care of our patients at Duke Health.


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