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Improving Airway Clearance for Children With Neurologic Impairment Hospitalized With Pneumonia
Amanda Warniment1,2, Anita Arnsperger3, Michael Rafferty3
1Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Insights
This study improved airway clearance therapies for hospitalized children with neurologic impairment (CNI) with pneumonia, increasing guideline adherence from 54% to 80% in six months. The quality improvement initiative enhanced care for CNI patients.
Area of Science:
- Pediatric Pulmonology
- Quality Improvement Science
- Clinical Practice Guidelines
Background:
- National guidelines for children with neurologic impairment (CNI) hospitalized with pneumonia were recently developed.
- A baseline adherence rate of 54% for recommended airway clearance therapies in CNI patients was identified.
Purpose of the Study:
- To increase the percentage of hospitalized CNI patients receiving guideline-concordant airway clearance therapies from 54% to 80% within one year.
- To implement and evaluate quality improvement methods for enhancing care delivery for CNI with pneumonia.
Main Methods:
- A multidisciplinary team utilized quality improvement (QI) methods, focusing on education, standardized respiratory therapy (RT) consults, electronic health record (EHR) order sets, and decision aids.
- Control charts monitored the mean percentage of CNI receiving airway clearance within 24 hours of admission.
- Process (RT evaluation orders), outcome (length of stay), and balancing (ICU transfer) measures were tracked.
Main Results:
- Mean adherence to airway clearance care recommendations increased from 54% to 80% within six months, demonstrating sustained improvement.
- Respiratory therapy evaluation orders increased during the quality improvement initiative.
- Length of stay and intensive care unit transfer rates remained unchanged, indicating no adverse effects.
Conclusions:
- Multidisciplinary education, standardized RT consults, and communication were key to implementing airway clearance recommendations.
- EHR modifications and decision aids supported the sustainability of these changes.
- Further research is needed to ascertain the impact of care recommendation concordance on patient outcomes in CNI.
Background And Objective:
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.
Methods:
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.
Results:
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.
Conclusion:
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.
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