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Effects of a QI intervention on pediatric asthma treatment using patient outcomes and workflow in an emergency
Mustafa Ozkaynak1, Claudia R Amura1, Marion R Sills2
1College of Nursing, Anschutz Medical Campus, University of Colorado, Denver, CO, USA.
Insights
A nurse-led quality improvement initiative significantly reduced the time to asthma treatment for pediatric patients in the emergency department (ED). This intervention improved evaluation and treatment timeliness, benefiting patient care.
Area of Science:
- Pediatric Emergency Medicine
- Quality Improvement Science
- Clinical Workflow Analysis
Background:
- Asthma is a common pediatric condition requiring timely and effective emergency department (ED) treatment.
- Existing ED protocols may not always ensure optimal efficiency in managing pediatric asthma exacerbations.
- Quality improvement (QI) initiatives are crucial for enhancing patient care processes in acute settings.
Purpose of the Study:
- To evaluate a nurse-initiated QI intervention designed to improve pediatric asthma treatment in an ED.
- To assess the impact of the intervention on patient outcomes and clinical workflow.
- To determine if QI efforts can enhance the timeliness of asthma care for children.
Main Methods:
- A pre-post analysis design was used to evaluate the QI intervention in a pediatric ED.
- Data from electronic health records (EHR) were analyzed for 886 pre-intervention visits and 752 post-intervention visits.
- Key metrics included time to clinical treatment, ED length of stay (EDLOS), admissions, discharges, and detailed clinical workflow timing.
Main Results:
- The time to the first documentation of the pediatric asthma score (PAS) significantly decreased by over 30 minutes post-intervention (p<.001).
- Significant reductions were observed in the time to steroid and bronchodilator administration (p<.001).
- For high-acuity patients discharged home, there were significant decreases in time to PAS, medication, and EDLOS; admitted high-acuity patients showed improved time to PAS but not treatment.
Conclusions:
- Nurse-initiated QI interventions can substantially improve the timeliness of pediatric asthma evaluation and treatment in the ED.
- Integrating workflow analysis with outcome evaluation provides deeper insights for QI initiatives.
- These findings support the implementation of similar nurse-driven QI programs to optimize pediatric asthma care.
Objective:
Evaluate a nurse-initiated quality improvement (QI) intervention aimed at enhancing asthma treatment in a pediatric emergency department (ED), utilizing outcomes and workflow.
Methods:
We evaluated the impact of QI interventions for pediatric patients presenting to the ED with asthma with pre-post analysis. A pediatric asthma score (PAS) of >8 indicated moderate to severe asthma. This secondary analysis of the electronic health record (EHR), evaluated on 1) patient outcomes (time to clinical treatment, ED length of stay [EDLOS], admissions and discharges home), 2) clinical workflow.
Results:
We compared 886 visits occurring between 01/01/2015 and 09/27/2015 (pre-implementation period) with 752 visits between 01/01/2016 and 09/27/2016 (post-implementation). Time to first documentation of PAS was decreased post-intervention (p<.001) by >30 min (75 ± 57 to 39 ± 54 min). There were significant decreases in time to treatment with both steroid and bronchodilator administration (both p<.001). EDLOS did not significantly change. Based on acuity level, those discharged home from the ED with high acuity (PAS score ≥8), had a significant decrease in time to initial PAS, steroid and bronchodilator use and EDLOS. Of those with high acuity who were admitted to the hospital, there was a difference pre- to post-implementation, in time to first PAS (p<.05), but not to treatment. Workflow visualization provided additional insights and detailed (task level) comparisons of the timing of ED activities.
Conclusions:
Nurse-initiated ED interventions, can significantly improve the timeliness of pediatric asthma evaluation and treatment. Examining workflow along with the outcomes, can better inform QI evaluations and clinical management.
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