Sneller Hannah, Keenan Kaitlin, Hoppa Eric
Division of Emergency Medicine, Children's Hospital and Medical Center, Omaha, Neb.
Department of Pediatrics, University of Nebraska Medical Center, Omaha, Neb.
Pediatr Qual Saf. 2020 Jun 8;5(3):e308. doi: 10.1097/pq9.0000000000000308. eCollection 2020 May-Jun.
Timely administration of corticosteroids improves asthma care in the pediatric emergency department (ED). Using the Model for Improvement, we aimed to decrease time to delivery of corticosteroids in patients presenting to the ED with an acute asthma exacerbation.
This is a single-center, prospective, multidisciplinary quality improvement (QI) project targeting ED patients 1-18 years of age with an acute asthma exacerbation. We collected 5 months of baseline data from the arrival time of an ED patient with an asthma exacerbation with a Modified Pulmonary Index Score ≥5 to the time of administration of corticosteroids. A quality improvement project was launched in October 2017 involving multiple Plan-Do-Study-Act ramps. Improvement interventions continued for 9 months through June 2018, including reeducation of residents and nurses in the ED asthma order set and nursing treatment protocols, respectively, and changes to the electronic health record. Data were tacked for 15 additional months until September 2019. To promote the use of the nursing treatment protocol, we utilized real-time improvement feedback and continuing nursing education.
The mean percentage of patients receiving steroids within 60 minutes of arrival improved from 59.3% to 84.3% over the first 5 months. The mean time to the administration of steroids within 60 minutes of arrival improved from 71.4 to 48.1 minutes. There was no increase in ED return rates.
Our project improved the percentage of patients with acute asthma exacerbations receiving steroids within 60 minutes of ED arrival and mean time to administration of steroids. We sustained improvement for 18 months after the implementation of our QI interventions.
及时给予皮质类固醇可改善儿科急诊科（ED）的哮喘护理。我们采用改进模型，旨在缩短急性哮喘加重期就诊于急诊科的患者接受皮质类固醇治疗的时间。
这是一项单中心、前瞻性、多学科质量改进（QI）项目，针对1 - 18岁急性哮喘加重期的急诊科患者。我们收集了5个月的基线数据，从哮喘加重且改良肺指数评分≥5的急诊科患者到达时间到给予皮质类固醇的时间。2017年10月启动了一项质量改进项目，涉及多个计划 - 实施 - 研究 - 改进循环。改进干预持续了9个月，直至2018年6月，包括分别对急诊科住院医师和护士进行哮喘医嘱集和护理治疗方案的再教育，以及对电子健康记录进行更改。数据又持续跟踪了15个月，直至2019年9月。为促进护理治疗方案的使用，我们利用了实时改进反馈和持续护理教育。
在最初的5个月里，到达后60分钟内接受类固醇治疗的患者平均百分比从59.3%提高到了84.3%。到达后60分钟内给予类固醇的平均时间从71.4分钟缩短至48.1分钟。急诊科复诊率没有增加。
我们的项目提高了急性哮喘加重期患者在急诊科到达后60分钟内接受类固醇治疗的百分比以及给予类固醇的平均时间。在实施质量改进干预措施后，我们持续改进了18个月。
