Neonatal Jaundice: Improved Quality and Cost Savings After Implementation of a Standard Pathway
| Autor: | Megan D. Fesinmeyer, Holly M. Romero, Darren S. Migita, Coral N. Ringer, Karen Kelly, Wren Haaland, Michael G. Leu, Elaine Beardsley, James B. Johnson |
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| Rok vydání: | 2018 |
| Předmět: |
Washington
medicine.medical_specialty Quality management media_common.quotation_subject MEDLINE Patient Readmission Time-to-Treatment 03 medical and health sciences 0302 clinical medicine Standard care Cost Savings 030225 pediatrics Humans Medicine Quality (business) 030212 general & internal medicine Hospitals Teaching Intensive care medicine media_common business.industry Infant Newborn Length of Stay Phototherapy Jaundice Hospitals Pediatric Hospital Charges Quality Improvement Jaundice Neonatal Cost savings Quality dimensions Pediatrics Perinatology and Child Health Critical Pathways Fluid Therapy medicine.symptom business Order set |
| Zdroj: | Pediatrics. 141 |
| ISSN: | 1098-4275 0031-4005 |
| DOI: | 10.1542/peds.2016-1472 |
| Popis: | OBJECTIVES: Seattle Children’s Hospital sought to optimize the value equation for neonatal jaundice patients by creating a standard care pathway. METHODS: An evidence-based pathway for management of neonatal jaundice was created. This included multidisciplinary team assembly, comprehensive literature review, creation of a treatment algorithm and computer order sets, formulation of goals and metrics, roll-out of an education program for end users, and ongoing pathway improvement. The pathway was implemented on May 31, 2012. Quality metrics before and after implementation were compared. External data were used to analyze cost impacts. RESULTS: Significant improvements were achieved across multiple quality dimensions. Time to recovery decreased: mean length of stay was 1.30 days for 117 prepathway patients compared with 0.87 days for 69 postpathway patients (P < .001). Efficiency was enhanced: mean time to phototherapy initiation was 101.26 minutes for 14 prepathway patients compared with 54.67 minutes for 67 postpathway patients (P = .03). Care was less invasive: intravenous fluid orders were reduced from 80% to 44% (P < .001). Inpatient use was reduced: 66% of prepathway patients were admitted from the emergency department to inpatient care, compared with 50% of postpathway patients (P = .01). There was no increase in the readmission rate. These achievements translated to statistically significant cost reductions in total charges, as well as in the following categories: intravenous fluids, laboratory, room cost, and emergency department charges. CONCLUSIONS: An evidence-based standard care pathway for neonatal jaundice can significantly improve multiple dimensions of value, including reductions in cost and length of stay. |
| Databáze: | OpenAIRE |
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