Related Experiment Videos
Implementing Respiratory Illness Care Pathways in General Hospitals: A Cluster Randomized Trial
Sunitha V Kaiser1, Yeelen R Edwards1, Charles E McCulloch1
1University of California, San Francisco, San Francisco, California.
Background And Objectives:
A prior study at a freestanding children's hospital tested simultaneous implementation of multiple clinical pathways and demonstrated improved guideline adherence and patient health outcomes. This high-efficiency approach has not been studied in general hospitals, which face unique implementation barriers. Our objective was to determine the effectiveness of a multi-condition pathway intervention in general hospitals.
Methods:
A pragmatic, cluster-randomized trial (1:1 allocation to intervention versus waitlist control) conducted from July 2022 to June 2024 in general hospitals across the United States. Admissions of children with a primary diagnosis of asthma, pneumonia, or bronchiolitis were analyzed. The intervention included inpatient pathways for asthma, pneumonia, and bronchiolitis implemented using audit and feedback, electronic order sets, iterative improvement cycles, and mentoring/facilitation. The primary outcome was mean composite adherence (percentage) across 7 evidence-based practices (2-3 analyzed for each diagnosis). Secondary outcomes included mean adherence to each practice, length of stay, transfer to intensive care, and 30-day hospital readmission or emergency revisit.
Results:
Forty-three hospitals were randomized, and 11 760 hospital admissions were analyzed. The intervention was associated with significant increases in mean composite adherence to evidence-based practices relative to control (absolute increase 9.9 percentage points [95% CI: 7.4-12.4]) and increases in 4 of 7 practices. It was also associated with a significant decrease in intensive care transfers (adjusted odds ratio 0.69 [95% CI 0.54-0.89]) but no significant effects on length of stay or 30-day readmission/revisit.
Conclusions:
The multicondition pathway intervention was effective in general hospitals, demonstrating significant improvements in adherence to evidence-based care over a sustained period.
Related Concept Videos
01:19Respiratory Assessment: Purpose and Indications
Objectives and Importance:
The primary goal of respiratory assessment is to evaluate patients at early risk of clinical deterioration. Since respiratory distress often precedes other signs of declining health, breathing patterns and sounds become a...
01:31Common Respiratory Disorders
Upper respiratory disorders impact the airways above the vocal cords, encompassing areas like the nose, sinuses, and throat. Various conditions fall under this category, including the common cold and allergic rhinitis. These disorders can stem from several causes,...
01:29Acute Respiratory Failure-V
Ensure that patients are monitored continuously for their response to therapy, including changes in...
01:30Pneumonia V: Nursing management and Prevention
The nurse must practice strict medical asepsis and adhere to infection control guidelines to minimize healthcare-associated infections.
Enhance airway patency
Position the patient correctly to facilitate drainage of the affected lung segments. Manual or mechanical percussion and vibration can also be employed.
01:28Pneumonia IV: Management
Bacterial Pneumonia Treatment
For bacterial pneumonia, antibiotics serve as the cornerstone of therapy. Initial treatment often begins with empirical antibiotics, tailored to the anticipated causative organism and adjusted based on culture results. Key antibiotic choices include:
01:23Assessment of Respiration
Subjective Assessment: Nurses interview the patient to gather information directly during the subjective assessment. It includes questions about the individual's medical history, medications, and symptoms, focusing on past respiratory conditions like asthma or COPD,...