Murphy Ashley, Lindegren Mary Lou, Schaffner William, Johnson David, Riley Lindsay, Chappell James D, Doyle Joshua D, Moen Anna Kate, Saxton Grant P, Shah Rahul P, Williams Derek J
Department of Pediatrics, Kaiser Permanente, Seattle, Washington.
Departments of Pediatrics and.
Hosp Pediatr. 2018 Sep;8(9):570-577. doi: 10.1542/hpeds.2017-0223. Epub 2018 Aug 14.
National guidelines recommend influenza testing for children hospitalized with influenza-like illness (ILI) during influenza season and treatment of those with confirmed influenza. Using quality improvement methods, we sought to increase influenza testing and treatment of children admitted to our hospital medicine service with ILI from 65% to 90% during the 2014-2015 influenza season.
We targeted several key drivers using multiple plan-do-study-act cycles. Interventions included awareness modules, biweekly flyers, and failure tracking. ILI admissions (fever plus respiratory symptoms) were reviewed weekly once surveillance data revealed elevated influenza activity. Appropriate testing and treatment of ILI was defined as influenza testing and/or treatment within 24 hours of admission unless a known cause other than influenza was present. We used statistical process control charts to track progress using established quality improvement methods. Appropriate testing and treatment was also assessed in the 2016-2017 influenza season by using similar methods, although no new interventions were introduced.
For the 2014-2015 season, appropriate testing and treatment increased from a baseline mean of 65% to 91% within 3 months. For the 2016-2017 season, appropriate testing and treatment remained at a mean of 80% throughout the influenza season.
Appropriate influenza testing and treatment increased to 90% in children with ILI during the 2014-2015 season. Improvements were sustained in a subsequent influenza season. Our initiative improved recognition of influenza and likely increased treatment opportunities. Future work should be focused on wider implementation and further reducing variation.
国家指南建议在流感季节对因流感样疾病（ILI）住院的儿童进行流感检测，并对确诊为流感的儿童进行治疗。我们运用质量改进方法，力求在2014 - 2015流感季节将我院内科收治的ILI患儿的流感检测和治疗比例从65%提高到90%。
我们通过多个计划 - 实施 - 研究 - 改进循环，针对几个关键驱动因素采取措施。干预措施包括开展认知培训模块、每两周发放一次传单以及进行失误追踪。一旦监测数据显示流感活动增加，每周对ILI住院病例（发热加呼吸道症状）进行审查。ILI的适当检测和治疗定义为入院后24小时内进行流感检测和/或治疗，除非存在已知的非流感病因。我们使用统计过程控制图，运用既定的质量改进方法来跟踪进展情况。在2016 - 2017流感季节，尽管未引入新的干预措施，但采用类似方法对适当检测和治疗情况进行了评估。
在2014 - 2015季节，3个月内适当检测和治疗比例从基线平均值65%提高到了91%。在2016 - 2017季节，整个流感季节适当检测和治疗比例平均保持在80%。
在2014 - 2015季节，ILI患儿的适当流感检测和治疗比例提高到了90%。在随后的流感季节，这一改善得以持续。我们的举措提高了对流感的识别能力，并可能增加了治疗机会。未来的工作应聚焦于更广泛的实施，并进一步减少差异。
