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Multidisciplinary Engagement Increases Medications in-Hand for Patients Hospitalized With Asthma
Kavita Parikh1, Karen Perry2, Candice Pantor2
1Children's National Hospital and the George Washington School of Medicine, Washington, District of Columbia kparikh@childrensnational.org.
Insights
Hospitalized children with asthma are now more likely to receive their discharge medications thanks to a new process. This improvement in medication possession at discharge aims to reduce future asthma exacerbations.
Area of Science:
- Pediatric Healthcare
- Respiratory Medicine
- Quality Improvement Science
Background:
- Asthma exacerbations in children are a significant cause of school absenteeism and healthcare utilization.
- A critical gap exists in ensuring children receive discharge prescriptions, increasing their risk for recurrent exacerbations.
Purpose of the Study:
- To enhance medication possession at discharge for pediatric asthma patients.
- To improve the transition of care for children hospitalized with asthma.
Main Methods:
- A multidisciplinary team implemented a quality improvement initiative using the model for improvement.
- Key strategies included process mapping, driver diagram development, and daily discharge huddles.
- Statistical process control charts monitored the proportion of patients receiving medications in-hand at discharge.
Main Results:
- Medication possession at discharge increased from 15% to over 80% for all eligible children.
- For children with public insurance, possession rates exceeded 90%.
- Length of stay and forgotten discharge medications remained stable.
Conclusions:
- Multidisciplinary collaboration is crucial for improving medication possession at discharge for pediatric asthma patients.
- Standardizing discharge processes can significantly enhance care transitions and potentially reduce readmissions.
Background:
Asthma exacerbations in children are a leading cause of missed school days and health care use. Patients discharged from the hospital often do not fill discharge prescriptions and are at risk for future exacerbations.
Methods:
A multidisciplinary team aimed to increase the percentage of patients discharged from the hospital after an asthma exacerbation with their medications in-hand from 15% to 80%. Tools from the model of improvement were used to establish a process map, key driver diagram, and iterative plan-do-study-act cycles. Statistical process control charts were used to track the proportion of patients discharged with their medications in-hand as the primary outcome. Initiating multidisciplinary daily discharge huddles on the unit was the key intervention that facilitated change in the system.
Results:
During the study period, the percentage of patients with asthma who received their medications in-hand increased from 15% to >80% for all eligible children and >90% for children with public insurance. Children had a median age of 6.7 years, 47% were female, and 83.8% identified as non-Hispanic African American. Through iterative meetings and mapping with the multidisciplinary team, a process map for bedside delivery and a key driver diagram were created. Balancing measures, specifically length of stay and discharge medications forgotten at the hospital, remained constant.
Conclusions:
Improvements in increasing medication possession at the time of discharge for children hospitalized with asthma were facilitated by multidisciplinary engagement. Standardizing discharge initiatives may play a key role in improving discharge transitions for children with asthma.
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