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Implementation of Postoperative Respiratory Care for Pediatric Orthopedic Patients
Erin E Shaughnessy1, Cynthia White2, Samir S Shah3
1Divisions of Hospital Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio erin.shaughnessy@cchmc.org.
Insights
A new respiratory care algorithm improved oxygenation outcomes for pediatric hip and spine surgery patients, especially those with chronic conditions. This quality improvement initiative empowered respiratory therapists and engaged families in postoperative care.
Area of Science:
- Pediatric Surgery
- Respiratory Care
- Quality Improvement
Background:
- One-fifth of pediatric hip and spine surgery patients require prolonged oxygen supplementation post-surgery.
- Postoperative atelectasis is a likely cause of prolonged oxygen need.
- Current respiratory care protocols may be insufficient for this patient group.
Purpose of the Study:
- To implement an innovative postoperative respiratory care algorithm for pediatric hip and spine surgery patients.
- To improve overall respiratory outcomes in this population.
- To reduce the incidence of prolonged oxygen supplementation.
Main Methods:
- A multidisciplinary team developed a care algorithm involving respiratory therapists (RTs) and patient/family engagement.
- The algorithm was implemented using rapid tests of change and monitored with run charts.
- A quasi-experimental design evaluated the association between algorithm implementation and prolonged oxygen use.
Main Results:
- Algorithm implementation achieved 80% reliability, with key interventions including RT education and automated orders.
- Overall prolonged oxygen use decreased from 21% to 16%, a non-significant change.
- In pediatric patients with chronic conditions, prolonged oxygen use significantly decreased from 22% to 6% (P = .04).
Conclusions:
- An innovative respiratory care algorithm was successfully implemented in pediatric hip and spine surgery patients.
- Empowering RTs and engaging families in care was central to the algorithm's success.
- The algorithm demonstrated a significant reduction in prolonged oxygen use for patients with chronic underlying conditions.
Background And Objectives:
At our institution, one-fifth of pediatric patients undergoing hip and spine surgery require prolonged oxygen supplementation, most likely due to postoperative atelectasis. Using quality improvement methodology, we aimed to implement an innovative postoperative respiratory care algorithm for hip and spine surgery patients, with a global aim of improving respiratory outcomes.
Methods:
A multidisciplinary team developed a care algorithm that relied on an activated respiratory therapist (RT) and engagement of patients and families. The algorithm was implemented via multiple rapid tests of change. Process measures representing the beginning and end of the care algorithm were plotted on standard run charts. We evaluated the association of algorithm implementation with a primary outcome of prolonged (>10 hours) oxygen supplementation via a quasi-experimental design using Fisher's exact and t tests.
Results:
The team successfully implemented the algorithm, with a reliability to process of 80%. Key interventions included education of RTs, a daily huddle, and implementation of automated orders. Among all hip and spine patients, algorithm implementation was associated with a small, non-statistically significant decrease in prolonged oxygen use (21% to 16%). Among patients with underlying chronic conditions, there was a significant decrease in prolonged oxygen use from 22% to 6% after algorithm implementation (P = .04).
Conclusions:
We implemented an innovative respiratory care algorithm in hip and spine surgery patients by empowering RTs and engaging families to participate in care. We found that this approach was associated with decreased prolonged oxygen use in patients with chronic underlying conditions.
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