Improving Airway Clearance for Children With Neurologic Impairment Hospitalized With Pneumonia

A national multidisciplinary expert panel recently developed care recommendations for children with neurologic impairment (CNI) hospitalized with pneumonia. We aimed to increase the percentage of CNI hospitalized with pneumonia to Pulmonary and Hospital Medicine services who received admission airway clearance therapies concordant with care recommendations from 54% to 80% over 1 year.

Our multidisciplinary team employed quality improvement (QI) methods to increase adherence to the new airway clearance care recommendations. Key drivers included knowledge of care recommendations, process standardization, effective communication, medical history documentation, and multidisciplinary buy-in. Interventions included education, standardization of respiratory therapy (RT) consults, electronic health record (EHR) order sets, and decision aids. Control charts with established rules for special cause tracked mean percentage of CNI receiving care recommendation-concordant airway clearance within 24 hours of admission. We followed RT evaluation orders as a process measure, length of stay (LOS; days) as an outcome measure, and intensive care unit (ICU) transfer as a balancing measure.

The mean percentage of hospitalized CNI receiving recommendation-concordant airway clearance increased from 54% to 80% over 6 months with sustained change following. RT evaluation orders increased over this time. The outcome measure of LOS and balancing measure of ICU transfer remained without change during the QI efforts.

Education, RT consult standardization, and multidisciplinary communication were instrumental for successful implementation of airway clearance care recommendations; EHR changes and decision aids facilitated sustained changes. Further study of patient outcomes is necessary to understand impact of care recommendation concordance in CNI.