Lo Huay-Ying, Messer Amanda, Loveless Jennifer, Sampayo Esther, Moore Robert H, Camp Elizabeth A, Macias Charles G, Quinonez Ricardo
Pediatric Hospital Medicine,
Pediatric Hospital Medicine, Louisiana State University Health Sciences Center and Children's Hospital, New Orleans, Louisiana.
Hosp Pediatr. 2018 Dec;8(12):733-739. doi: 10.1542/hpeds.2018-0072. Epub 2018 Nov 1.
Asthma exacerbations are a leading cause of hospitalization among children. Despite the existence of hospital protocols and national guidelines, little guidance is available regarding appropriate short-acting β-agonist (SABA) frequency discharge criteria. Our aim was to reduce the median length of stay (LOS) for children hospitalized with asthma exacerbations by 4 hours by changing the discharge requirement SABA frequency.
Multiple plan-do-study-act cycles based on findings in our key driver diagram were used to decrease LOS. Our primary intervention was reducing the SABA administration frequency discharge requirement from every 4 hours to every 3 hours. After a feasibility pilot, this change was implemented throughout the hospital. Our intervention bundle included updating our evidence-based guidelines, electronic health record order sets and note templates, house-wide education, and a new process for respiratory therapists to notify physicians of discharge readiness. Our primary metric was LOS, with 3-, 7-, and 14-day same-cause emergency department (ED) revisits and hospital readmissions as balancing metrics. Statistical process control charts and nonparametric testing were performed for data analysis.
Median hospital LOS was significantly lower in the postintervention period compared with the preintervention period (30.18 vs 36.14 hours respectively; < .001). Statistical process control charts indicated special cause variation was achieved. No significant differences were observed in rates of ED revisits or hospital readmissions.
Reducing the discharge requirement of SABA frequency from every 4 hours to every 3 hours resulted in a reduction in LOS, with no increase in ED recidivism or hospital readmission rates.
哮喘急性发作是儿童住院的主要原因。尽管存在医院协议和国家指南，但关于适当的短效β受体激动剂（SABA）给药频率出院标准的指导却很少。我们的目标是通过改变出院时SABA给药频率的要求，将因哮喘急性发作住院儿童的中位住院时间（LOS）缩短4小时。
基于关键驱动因素图的结果，采用多个计划-执行-研究-行动循环来缩短住院时间。我们的主要干预措施是将SABA给药频率的出院要求从每4小时一次降至每3小时一次。在可行性试点之后，这一改变在全院实施。我们的干预措施包括更新循证指南、电子健康记录医嘱集和病历模板、全院范围的教育，以及呼吸治疗师通知医生患儿已准备好出院的新流程。我们的主要指标是住院时间，将3天、7天和14天内因相同病因的急诊科（ED）复诊和再次住院作为平衡指标。进行统计过程控制图和非参数检验以进行数据分析。
与干预前相比，干预后时期的医院中位住院时间显著缩短（分别为30.18小时和36.14小时；P<0.001）。统计过程控制图表明实现了特殊原因变异。在急诊科复诊率或再次住院率方面未观察到显著差异。
将SABA给药频率的出院要求从每4小时一次降至每3小时一次可缩短住院时间，且不会增加急诊科再就诊率或再次住院率。
