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Reducing pediatric asthma hospital length of stay through evidence-based quality improvement and deployment of computerized provider order entry.

Authors
  • Gellert, George A1
  • Davenport, Crystal M2
  • Minard, Charles G3
  • Castano, Claudia2
  • Bruner, Kylynn1
  • Hobbs, Deon2
  • 1 Department of Health Informatics, CHRISTUS Health Santa Rosa, San Antonio, TX, USA.
  • 2 CHRISTUS Health Santa Rosa and Baylor College of Medicine, Department of Pediatrics, Children's Hospital of San Antonio, San Antonio, TX, USA.
  • 3 Baylor College of Medicine, Dan L. Duncan Institute for Clinical and Translational Research, Houston, TX, USA.
Type
Published Article
Journal
Journal of Asthma
Publisher
Informa UK (Taylor & Francis)
Publication Date
Feb 01, 2020
Volume
57
Issue
2
Pages
123–135
Identifiers
DOI: 10.1080/02770903.2018.1553053
PMID: 30678502
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Objective: Evaluate the impact of multi-component quality improvement for pediatric asthma care focusing on serial use of an evidence-based clinical pathway via paper order sets, pathway integration into computerized provider order entry (CPOE), use of a clinical respiratory score (CRS) and a discharge checklist. Methods: Outcomes were assessed over three intervention periods and 50 months on: time to beta-agonist and steroid first administration, frequency of readmissions and hospital length of stay. A general linear model estimated mean log(LOS) over time and between study periods. Time to discharge was transformed using the natural logarithm. Results: No improvements in time to first beta-agonist or steroid administration were observed. There was a reduction in 100-day readmissions (p = 0.008): decreasing from 7.4 to 2.1% after introduction of paper order sets and CRS (adjusted p = 0.04); to 3.9% after CPOE implementation (adjusted p = 0.53) and to 2.2% when a discharge checklist was added (adjusted p = 0.01). There was a statistically significant reduction in LOS between study periods (p = 0.015). The geometric mean LOS in hours during study periods 1-4 were: 34.8 (95% CI: 32.2, 37.6), 29.3 (95% CI: 27.5, 31.3), 29.0 (95% CI: 27.0, 31.3) and 23.1 (95% CI: 22.1, 24.2). Pair-wise comparisons between periods were statistically significant (adjusted p ≤ 0.003), except for Periods 2 and 3 (adjusted p = 0.83). Conclusions: Hospital length of stay and 100-day readmissions rate in a predominantly Hispanic, Medicaid patient population were reduced by utilization of an evidence-based best practices asthma management pathway and CRS within CPOE, combined with a checklist to expedite discharge.

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