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Decreasing Door-to-Door Times for Infliximab Infusions in a Children's Hospital Observation Unit
Kelly C Sandberg1,2, Janet N Lucien3, Denise Stoll1
1Department of Gastroenterology, Dayton Children's Hospital, Dayton, Ohio.
Insights
Rapid infliximab infusions significantly reduced hospital time for pediatric inflammatory bowel disease (IBD) patients, freeing up over 12 hours annually per child. This change improved family time without compromising patient safety during treatment.
Area of Science:
- Pediatric Gastroenterology
- Clinical Quality Improvement
Background:
- Pediatric inflammatory bowel disease (IBD) management often necessitates infliximab infusions.
- Current hospital-based infusion protocols lead to substantial time away from home for patients and families.
Purpose of the Study:
- To implement and evaluate a rapid infliximab infusion protocol for pediatric IBD patients.
- To decrease the duration of hospital visits and improve patient and family quality of life.
Main Methods:
- A 4-month quality improvement initiative was undertaken.
- Key changes included a standardized order set, rapid infusions for eligible patients, elimination of post-infusion observation, and enhanced pharmacy preparation.
- Tools such as smart aim, driver diagrams, PDSA cycles, and SPC charts were employed.
Main Results:
- Average patient hospital time decreased by 128 minutes (2 hours 8 minutes) within three months.
- This translates to an annual time saving of 768 minutes (12 hours 48 minutes) per patient.
- No infusion reactions were observed during the study period.
Conclusions:
- Rapid infliximab infusion protocols can significantly reduce pediatric IBD patient hospital time.
- This approach enhances family time without compromising patient safety.
- The implemented changes offer a model for other institutions seeking to optimize infusion efficiency.
Introduction:
Children with inflammatory bowel disease (IBD) often require infliximab infusions to manage their disease. Infusions administered in the hospital setting require the patient and their families to devote many hours away from home. Changing to a rapid infusion protocol has been shown in the literature to be safe and has the potential to decrease time spent in the hospital receiving infusions.
Methods:
We describe stepwise changes made over a 4-month period to improve infliximab infusion efficiency and lessen the time spent in the hospital by IBD patients and their families. These changes included the implementation of a standardized order set, defaulting to rapid infusions for eligible patients, eliminating the post-infusion observation window, and improving the pharmacy's efficiency in preparing infusion medications. We utilized several established quality improvement tools, including a smart aim, key driver diagram, plan-do-study-act cycles, and statistical process control charts to measure these interventions.
Results:
Within three months of starting, the average door-to-door time patients spent in the hospital decreased by 128 minutes (2 hours 8 minutes). This improvement amounts to 768 minutes (12 hours 48 minutes) per year of time returned for normal childhood activities outside of the hospital. There were no infusion reactions during the period monitored.
Conclusions:
Implementation of a rapid infliximab infusion protocol made an impressive impact on freed family time without sacrificing patient safety. The changes we implemented could be helpful to other centers interested in decreasing in-hospital time for patients with IBD and their families.