.jpg "Merrick Lopez, MD photo")
Gulixian Abudukadier, RN
RN
Loma Linda University, United States
Disclosure information not submitted.
Harsha Chandnani, MBA, MD, MPH
Assistant Professor of Pediatrics
Loma Linda University, United States
Disclosure information not submitted.
Carissa Cianci, MA, RN, CPHQ
MA, RN, CPHQ
Loma Linda University, United States
Disclosure information not submitted.
Ekua Cobbina, MD
Assistant Professor
Loma Linda University Children's Hospital, California, United States
Disclosure information not submitted.
Julie Fluitt, BSN, RN, CCRN
RN
Loma Linda Univ Children's Hospital, United States
Disclosure information not submitted.
Michele Grainger
RCP
Loma Linda University Children’s Hosital, United States
Disclosure information not submitted.
Danny Kaufman, RCP
RCP
Loma Linda University Children’s Hosital, United States
Disclosure information not submitted.
Anthony Moretti, MBA, MD
Assistant Professor
Loma Linda University Children's Hospital, United States
Disclosure information not submitted.
Robert Ruiz, RN
EHR Application Specialist
Loma Linda University, United States
Disclosure information not submitted.
Michael Tiras, RCP
RCP
Loma Linda University Children's Hospital, United States
Disclosure information not submitted.
Michele Wilson, MS, RN, NP, CCNS, CCRN-K
PICU & Peds Step Down ICU Clinical Nurse Specialist
Loma Linda University Children's Hospital, United States
Disclosure information not submitted.
Title: Implementing a Standardized Respiratory Care Driven Electronic Pathway for Status Asthmaticus
Introduction: Status asthmaticus (SA) is a common reason for pediatric hospitalization. The goal of this study is to describe the impact of a standardized pathway for SA in the electronic medical record (EMR) of a pediatric intensive care unit (PICU).
Methods: This quality improvement initiative was implemented in a 25-bed multidisciplinary PICU in a tertiary children's hospital. A standardized respiratory score (RS) was adopted and internally validated by staff; physicians, nurses, and respiratory care practitioners (RCPs) in February 2017 to use for patients admitted with SA. The RS was then used to determine weaning schedules for Albuterol and steroid therapies. Pharmacy and information technology (IT) staff developed an electronic SA pathway within our EMR system, using best practice alerts (BPAs). These BPAs informed staff to initiate the pathway, wean/escalate treatment, transition to oral steroids, transfer level of care, and complete discharge education. In October 2018, the clinical pathway was implemented in the PICU, stepdown (SD) ICU, and acute care areas. Pre- and post-intervention metrics were assessed (pre-pandemic). Process control charts were used to demonstrate the progression of mean asthma data from pre-intervention to post-intervention for percent order set utilization, lengths of stay (LOS), and modes of respiratory support. These metrics were compared using Welch's t-tests with a significance level of 0.05.
Results: A total of 598 patients were analyzed pre-intervention and 304 patients post-intervention. Order set utilization significantly increased from 68 to 97% (0.001), PICU LOS decreased from 38.4 to 31.1 hours (p=0.013), SD ICU LOS decreased from 25.7 to 20.9 hours(p=0.01), and overall hospital LOS decreased from 59.5 to 50.7 hours (p=0.003). The LOS reduction resulted in overall hospital cost savings of $1,216,000 for the patient cohort. There were no differences in mode of respiratory support, mechanical ventilation, mortality rate, or readmission rate.
Conclusions: Implementation of a standardized RCP-driven electronic pathway for children with SA led to significantly increased order set utilization and decreased ICU and hospital lengths of stay. Leveraging IT and standardized pathways for common diagnoses can lead to improved quality of care, outcomes, and cost savings.