Improving the Efficiency of Care for Pediatric Patients Hospitalized With Asthma.
Improving the Efficiency of Care for Pediatric Patients Hospitalized With Asthma.
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DOI：
10.1542/hpeds.2016-0108
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发表时间：
2017-01-01
影响因子：
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通讯作者：
McLean, Heather S
中科院分区：
文献类型：
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作者：
Bartlett, Kathleen W;Parente, Victoria M;McLean, Heather S
背景：哮喘恶化是儿童住院的主要原因。尽管存在国家儿科哮喘指南，但护理的显著差异仍然存在。在杜克儿童医院，我们确定我们的平均住院时间（ALOS）和儿童哮喘住院费用超过了我们的同行。我们的目的是减少ALOS的儿科哮喘住院患者从2.9天到2.6天内12个月内通过实施哮喘路径在我们的新的电子healthrecords.METHODS：我们召集了一个多学科委员会负责减少实践中的变异性，ALOS，和住院儿科哮喘护理的成本，同时坚持循证指南。通过多个“计划-实施-研究-行动”周期对干预措施进行测试。构建ALOS控制图，并注释干预措施，包括哮喘评分测试，实施订单集，使用呼吸治疗驱动的沙丁胺醇治疗方案，并提供有针对性的教育。将订单集使用情况作为流程度量进行审核。再入院率作为一个平衡measurement.Results：哮喘住院患儿的ALOS显着下降，从2.9天到2.3天。将基线与干预变量直接成本数据进行比较，发现每例节省1543美元。在高度遵守哮喘途径命令集的背景下，情况有所改善。再入院率在整个研究期间保持稳定。结论：实施基于电子健康记录的哮喘护理路径提高了医院护理的效率和可变直接成本，减少了实践中的变异性，并确保遵守高质量的国家指南。
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.