Improving Guideline-Based Care of Acute Asthma in a Pediatric Emergency Department
| Autor: | Michael J. Grahl, Marc H. Gorelick, Matthew P. Gray, Grant E. Keeney, Christopher D. Spahr |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
Pediatric emergency
medicine.medical_specialty Adolescent Psychological intervention Severity of Illness Index 03 medical and health sciences 0302 clinical medicine Patient Admission Wisconsin Pediatric emergency medicine 030225 pediatrics medicine Humans Child Adrenergic beta-2 Receptor Agonists Process Measures Asthma Clinical Audit business.industry 030208 emergency & critical care medicine Guideline Emergency department medicine.disease Hospitals Pediatric Triage Quality Improvement Outcome and Process Assessment Health Care Child Preschool Pediatrics Perinatology and Child Health Emergency medicine Practice Guidelines as Topic Guideline Adherence business Emergency Service Hospital |
| Zdroj: | Pediatrics. 138(5) |
| ISSN: | 1098-4275 |
| Popis: | BACKGROUND AND OBJECTIVE: Rapid repetitive administration of short-acting β-agonists (SABA) is the most effective means of reducing acute airflow obstruction in asthma. Little evidence exists that assesses process measures (ie, timeliness) and outcomes for asthma. We used quality improvement (QI) methods to improve emergency department care in accordance with national guidelines including timely SABA administration and use of asthma severity scores. METHODS: The Model for Improvement was used and interventions were targeted at 4 key drivers: knowledge, engagement, decision support, and workflow enhancement. Time series analysis was performed and outcomes assessed on statistical process control charts. RESULTS: Asthma severity scoring increased from 0% to >95% in triage and to >75% for repeat scores. Time to first SABA (T1) improved by 32.8 minutes (47%). T1 for low severity patients improved by 17.6 minutes (28%). T1 for high severity patients improved by 3.1 minutes to 18.1 minutes (15%). Time to third SABA (T3) improved by 30 minutes (24%). T3 for low severity patients improved by 42.5 minutes (29%) and T3 for high severity patients improved by 21 minutes (23%). Emergency department length of stay for low severity patients discharged to home improved by 29.3 minutes (15%). The number of asthma-related visits between 48-hour return hospitalizations increased from 114 to 261. The admission rate decreased 6.0%. CONCLUSIONS: We implemented standardized asthma severity scoring with high rates of compliance, improved timely administration of β-agonist treatments, demonstrated early improvements in Emergency department length of stay, and reduced admission rates without increasing unplanned return admissions. |
| Databáze: | OpenAIRE |
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