RESUMEN
OBJECTIVES: The objective of this study was to evaluate ordering of albuterol via metered-dose inhaler with spacer (MDI-spacer), length of stay (LOS), and 72-hour return rates before and after publication of an internally developed pediatric asthma clinical practice guideline (CPG). METHODS: The internally developed CPG reflected national recommendations. It was explained at faculty meetings by a respected clinician and published on the intranet on February 6, 2012. We performed a retrospective study of visits from January 1, 2009, to October 31, 2014, by children aged 2 to 17 years with a primary diagnosis of asthma and discharged from a target site (2 pediatric emergency departments and 1 urgent care center). We excluded critical/emergent visits and those by patients who transferred to the emergency department/urgent care center from another facility or were admitted. We extracted data for 37 months before and 33 months after CPG implementation (post-CPG) using a single electronic health record system. RESULTS: Albuterol delivery via MDI-spacer increased by 33.95% (P < 0.0001) during 1-month post-CPG implementation with no significant subsequent decrease. An unexpected decline was noted for median LOS before CPG implementation (-1.24 minutes; P < 0.0001). For MDI-spacer-treated patients post-CPG, decreased median LOS was maintained and there was decreased variability of the median LOS (P < 0.001). For nebulizer-treated patients post-CPG, median LOS increased (.95 minutes; P = 0.033). No change was observed for 72-hour return rates. CONCLUSIONS: Implementation of an asthma CPG increased ordering of albuterol via MDI-spacer. The increase was sustained over time in all study sites. Decreased variability in median LOS for MDI-spacer patients was observed post-CPG. Median LOS for those treated with MDI-spacer exclusively remained unchanged in the post-CPG period, whereas post-CPG LOS increased in those who received nebulized albuterol.
Asunto(s)
Albuterol/administración & dosificación , Asma/tratamiento farmacológico , Broncodilatadores/administración & dosificación , Aceptación de la Atención de Salud/estadística & datos numéricos , Adolescente , Instituciones de Atención Ambulatoria/estadística & datos numéricos , Niño , Preescolar , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Inhaladores de Dosis Medida , Readmisión del Paciente/estadística & datos numéricos , Guías de Práctica Clínica como Asunto , Estudios RetrospectivosAsunto(s)
Enfermería Basada en la Evidencia/organización & administración , Becas , Evaluación de Resultado en la Atención de Salud , Práctica Clínica Basada en la Evidencia/organización & administración , Humanos , Innovación Organizacional , Enfermería Pediátrica/organización & administración , Desarrollo de Programa , Evaluación de Programas y Proyectos de Salud , Sociedades de EnfermeríaRESUMEN
Radiographic evaluation for necrotizing enterocolitis (NEC) often yields nonspecific findings. Bowel ultrasound (BUS) provides additional information beyond that of abdominal radiographs and may be helpful in the diagnosis of NEC in neonates. We systematically reviewed and aggregated existing literature to get a better estimate of diagnostic accuracy of BUS in the diagnosis of NEC. A literature search was performed using PubMed, Embase, and Cumulative Index to Nursing and Allied Health Literature to identify studies in which infants with clinically suspected NEC were evaluated using BUS. Studies that used modified Bell staging criteria as the reference standard were included. Study quality was assessed, and pooled sensitivity and specificity of various BUS findings for diagnosing NEC were determined. Six articles with a total of 462 patients met eligibility and inclusion criteria. There was heterogeneity in BUS findings evaluated across studies. Ultrasound detection of classic signs of NEC (portal venous gas, pneumatosis, and free air) had pooled sensitivities ranging from 0.27 to 0.48 and pooled specificities ranging from 0.91 to 0.99. Bowel wall thinning and absent peristalsis had overall low sensitivity (0.22 and 0.30) but high specificity (0.96 and 0.96) for NEC. Assessment of abdominal fluid, which included ascites and focal fluid collection, also had overall low sensitivity and high specificity (simple ascites: 0.45 and 0.92; focal fluid collection: 0.19 and 0.98). In summary, individual BUS findings have low sensitivity and high specificity for diagnosis of NEC. Bowel ultrasound may be a useful adjunct to plain abdominal radiographs in the evaluation of infants with clinical suspicion of NEC.