Discharging Asthma Patients on 3-Hour ß-Agonist Treatments: A Quality Improvement Project.
Hosp Pediatr
; 8(12): 733-739, 2018 12.
Article
de En
| MEDLINE
| ID: mdl-30385459
ABSTRACT
OBJECTIVES:
Asthma exacerbations are a leading cause of hospitalization among children. Despite the existence of hospital protocols and national guidelines, little guidance is available regarding appropriate short-acting ß-agonist (SABA) frequency discharge criteria. Our aim was to reduce the median length of stay (LOS) for children hospitalized with asthma exacerbations by 4 hours by changing the discharge requirement SABA frequency.METHODS:
Multiple plan-do-study-act cycles based on findings in our key driver diagram were used to decrease LOS. Our primary intervention was reducing the SABA administration frequency discharge requirement from every 4 hours to every 3 hours. After a feasibility pilot, this change was implemented throughout the hospital. Our intervention bundle included updating our evidence-based guidelines, electronic health record order sets and note templates, house-wide education, and a new process for respiratory therapists to notify physicians of discharge readiness. Our primary metric was LOS, with 3-, 7-, and 14-day same-cause emergency department (ED) revisits and hospital readmissions as balancing metrics. Statistical process control charts and nonparametric testing were performed for data analysis.RESULTS:
Median hospital LOS was significantly lower in the postintervention period compared with the preintervention period (30.18 vs 36.14 hours respectively; P < .001). Statistical process control charts indicated special cause variation was achieved. No significant differences were observed in rates of ED revisits or hospital readmissions.CONCLUSIONS:
Reducing the discharge requirement of SABA frequency from every 4 hours to every 3 hours resulted in a reduction in LOS, with no increase in ED recidivism or hospital readmission rates.
Texte intégral:
1
Collection:
01-internacional
Base de données:
MEDLINE
Sujet principal:
Sortie du patient
/
Asthme
/
Volume expiratoire maximal par seconde
/
Antiasthmatiques
/
Agonistes des récepteurs béta-2 adrénergiques
/
Amélioration de la qualité
Type d'étude:
Guideline
Limites:
Child
/
Child, preschool
/
Female
/
Humans
/
Male
Pays/Région comme sujet:
America do norte
Langue:
En
Journal:
Hosp Pediatr
Année:
2018
Type de document:
Article