Improving Pediatric Intensive Care Unit Discharge Timeliness of Infants with Bronchiolitis Using Clinical Decision...

Area of Science:

• Pediatric Intensive Care
• Clinical Informatics
• Quality Improvement Initiatives

Background:

• Pediatric intensive care unit (PICU) patient transfer requires efficient identification of suitable candidates.
• A prior quality improvement (QI) initiative aimed to expedite transfer evaluations for non-medically complex PICU patients with bronchiolitis.
• Manual tracking of patient respiratory support was a limitation in the previous initiative.

Purpose of the Study:

• To design and implement an electronic health record (EHR)-based clinical decision support (CDS) tool.
• To automate the identification of PICU patients ready for transfer.
• To further accelerate the transfer evaluation process initiated by the QI program.

Main Methods:

• Developed an EHR-based CDS tool to automatically identify patients meeting QI criteria.
• The tool alerts clinicians when patients have received floor-appropriate respiratory support for at least 6 hours.
• Compared time-to-transfer, PICU length of stay (LOS), and hospital LOS across pre-QI, QI, and CDS implementation phases.

Main Results:

• The CDS phase showed a significantly shorter median time-to-transfer (5.23 hours) compared to the QI phase (5.93 hours).
• PICU and hospital length of stay (LOS) decreased from the pre-QI to the QI phase.
• While LOS reductions were maintained in the CDS phase, further significant decreases were not observed.

Conclusions:

• An EHR-based CDS tool effectively adapted a QI initiative to expedite the identification of PICU patients for transfer.
• This automated approach allows PICU clinicians to focus on high-acuity tasks.
• The CDS tool facilitates timely transfer evaluations for appropriate pediatric patients.