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Reducing Inpatient Length of Stay Using a Multicollaborative Protocol for Management of Non-Intensive Care Unit

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A new asthma protocol significantly reduced inpatient length of stay (LOS) for pediatric patients. This respiratory therapist-led approach used a standardized weaning algorithm and metered dose inhaler (MDI) with valved holding chamber (VHC).

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Area of Science:

  • Pediatric Pulmonology
  • Healthcare Management
  • Clinical Protocol Optimization

Background:

  • Hospital administrators aim to enhance clinical efficiency by reducing inpatient length of stay (LOS).
  • Healthcare reimbursement changes necessitate improved hospital operational and financial outcomes.
  • Standardized protocols are key to managing patient care and resource utilization effectively.

Purpose of the Study:

  • To evaluate the impact of a novel inpatient asthma protocol on clinical and financial outcomes.
  • To assess a protocol integrating a respiratory therapist (RT)-driven bronchodilator weaning algorithm and metered dose inhaler (MDI) with valved holding chamber (VHC) delivery.
  • To determine if this protocol reduces length of stay and affects hospital charges and readmission rates.

Main Methods:

  • A pre-post study design was employed, analyzing patients aged 2-21 with status asthmaticus.
  • Data collected included patient demographics, LOS, all-patient refined diagnosis-related groups (APR-DRGs), and inpatient charges.
  • Statistical analysis utilized Wilcoxon signed-rank test and bootstrap logistic regression models to compare pre- and post-implementation periods.

Main Results:

  • The protocol group (n=110) showed a significantly reduced LOS compared to the non-protocol group (n=150), maintaining significance after adjusting for APR-DRGs weight (P < 0.05).
  • Total hospital billing charges were not significantly altered by the protocol implementation.
  • A trend towards reduced 30-day readmission rates was observed, though not statistically significant.

Conclusions:

  • An RT-led asthma protocol utilizing a quantitative scoring system and MDI+VHC for bronchodilator administration significantly decreases inpatient length of stay.
  • The protocol optimizes clinical efficiency without negatively impacting hospital charges.
  • Further investigation into readmission rates may be warranted.