A Quality Improvement Approach to Influence Value-based Mucolytic Use in the PICU.

Area of Science:

• Pediatric Critical Care Medicine
• Health Economics
• Clinical Pathway Development

Background:

• High-cost medications without evidence reduce healthcare value.
• Dornase alfa use in critically ill, mechanically ventilated children lacked supporting evidence.
• Reducing unnecessary dornase alfa utilization was the primary objective.

Purpose of the Study:

• To decrease dornase alfa utilization in critically ill pediatric patients.
• To implement a value-based clinical pathway for mucolytic selection.
• To improve healthcare value by optimizing medication use.

Main Methods:

• An observational pre-post design was used in a quaternary pediatric intensive care unit.
• A clinical pathway guided mucolytic choice, favoring hypertonic saline and N-acetylcysteine over dornase alfa.
• Interventions included physician education and pathway rollout; control charts monitored orders.

Main Results:

• Dornase alfa starts decreased by 53% and total doses by 75% per 100 patient days.
• Use of hypertonic saline and N-acetylcysteine increased, with no adverse effects noted.
• Mucolytic costs reduced by 59% ($2183.08 to $885.77 per 100 patient days).

Conclusions:

• A clinical pathway prioritizing pharmacoeconomics improved healthcare value.
• Evidence-based medication selection enhanced patient care without negative outcomes.
• Value-based pathways are effective for optimizing high-cost medication use.