Decreasing ICU and Hospital Length of Stay through a Standardized Respiratory Therapist-driven Electronic Clinical Care Pathway for Status Asthmaticus.

IF 1.2 Q3 PEDIATRICS
Pediatric quality & safety Pub Date : 2023-12-05 eCollection Date: 2023-11-01 DOI:10.1097/pq9.0000000000000697
Merrick Lopez, Michele Wilson, Ekua Cobbina, Danny Kaufman, Julie Fluitt, Michele Grainger, Robert Ruiz, Gulixian Abudukadier, Michael Tiras, Bronwyn Carlson, Jeane Spaid, Kim Falsone, Invest Cocjin, Anthony Moretti, Chad Vercio, Cynthia Tinsley, Harsha K Chandnani, Carlos Samayoa, Carissa Cianci, James Pappas, Nancy Y Chang
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Abstract

Introduction: Status asthmaticus (SA) is a cause of many pediatric hospitalizations. This study sought to evaluate how a standardized asthma care pathway (ACP) in the electronic medical record impacted the length of stay (LOS).

Methods: An interdisciplinary team internally validated a standardized respiratory score for patients admitted with SA to a 25-bed pediatric intensive care unit (PICU) at a tertiary children's hospital. The respiratory score determined weaning schedules for albuterol and steroid therapies. In addition, pharmacy and information technology staff developed an electronic ACP within our electronic medical record system using best practice alerts. These best practice alerts informed staff to initiate the pathway, wean/escalate treatment, transition to oral steroids, transfer level of care, and complete discharge education. The PICU, stepdown ICU (SD ICU), and acute care units implemented the clinical pathway. Pre- and postintervention metrics were assessed using process control charts and compared using Welch's t tests with a significance level of 0.05.

Results: Nine hundred two consecutive patients were analyzed (598 preintervention, 304 postintervention). Order set utilization significantly increased from 68% to 97% (P < 0.001), PICU LOS decreased from 38.4 to 31.1 hours (P = 0.013), and stepdown ICU LOS decreased from 25.7 to 20.9 hours (P = 0.01). Hospital LOS decreased from 59.5 to 50.7 hours (P = 0.003), with cost savings of $1,215,088 for the patient cohort.

Conclusions: Implementing a standardized respiratory therapist-driven ACP for children with SA led to significantly increased order set utilization and decreased ICU and hospital LOS. Leveraging information technology and standardized pathways may improve care quality, outcomes, and costs for other common diagnoses.

通过标准化呼吸治疗师驱动的电子临床护理途径减少哮喘患者的ICU和住院时间。
简介:状态哮喘(SA)是许多儿科住院的原因。本研究旨在评估电子病历中的标准化哮喘护理途径(ACP)如何影响住院时间(LOS)。方法:一个跨学科团队内部验证了在一家三级儿童医院25张床位的儿科重症监护病房(PICU)住院的SA患者的标准化呼吸评分。呼吸评分决定了沙丁胺醇和类固醇治疗的脱机时间表。此外,药房和信息技术人员在我们的电子病历系统中使用最佳实践警报开发了一个电子ACP。这些最佳实践警报通知工作人员启动途径,停止/升级治疗,过渡到口服类固醇,转移护理水平,并完成出院教育。PICU、降级ICU (SD ICU)和急症监护室实施临床路径。采用过程控制图评估干预前后指标,采用Welch’st检验进行比较,显著性水平为0.05。结果:共分析992例患者(干预前598例,干预后304例)。订单组利用率从68%上升到97% (P < 0.001), PICU的LOS从38.4小时下降到31.1小时(P = 0.013), stepdown ICU的LOS从25.7小时下降到20.9小时(P = 0.01)。住院时间从59.5小时减少到50.7小时(P = 0.003),为患者队列节省成本1,215,088美元。结论:对SA患儿实施标准化的呼吸治疗师驱动的ACP可显著提高医嘱集利用率,降低ICU和医院LOS。利用信息技术和标准化途径可以改善其他常见诊断的护理质量、结果和成本。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
2.20
自引率
0.00%
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审稿时长
20 weeks
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