ASTHMA CARE STANDARDIZATION IN A PEDIATRIC EMERGENCY DEPARTMENT: CHANGING TO DISCHARGE MEDICATIONS IN-HAND AND UNDERSTANDING EFFECTS ACROSS THE CARE CONTINUUM. Issue 12 (18th November 2016)

• Record Type: Journal Article
• Authors: Kurowski, Eileen Murtagh; Rinderknecht, Andrea; Caruso, Michelle; Oehler, Jennifer; Varadarajan, Kartik; Doughty, Lesley; Gordon, Catherine; Kercsmar, Carolyn; Mansour, Mona; McDowell, Karen; Simmons, Jeffrey; Iyer, Srikant
• Is Part Of: BMJ quality & safety. Volume 25:Issue 12(2016)
• Page Start: 1008
• Page End: 1008
• Publication Date: 2016-11-18
• Subjects: Accreditation -- Anaesthesia -- Attitudes; Medical care -- Quality control -- Periodicals; Health facilities -- Risk management -- Periodicals; Medical errors -- Prevention -- Periodicals; 362.106805
• DOI: 10.1136/bmjqs-2016-IHIabstracts.22
• Languages: English
• ISSNs: 2044-5415

Abstract

Abstract : Background: Provision of medications in-hand at discharge improves adherence with recommended therapy. Objectives: Among patients discharged from our emergency departments(ED)/urgent cares(UC) with an acute asthma exacerbation, we aimed to provide oral corticosteroid (OCS) in-hand so families did not have to fill a prescription after discharge. Methods: Our multidisciplinary team created a key driver diagram to make explicit our theory for improvement. Key drivers included effective decision support, readily available medication with standard dispensing process, and provider education. Multiple plan-do-study-act cycles were conducted to address key drivers. Our primary outcome was provision of OCS in-hand at time of discharge and our secondary outcome was change to dexamethasone as preferred OCS in ED. Proportion of patients with a return visit within 7 days who required additional OCS was tracked as a balancing measure to ensure there were no unintended consequences. Results: Statistical process control charts illustrated special cause variation in both our primary (2% to 96%, figure 1) and secondary (17% to 95%, figure 2) outcome measures. Our balancing measure remained was stable demonstrating only common cause variation (figure 3). Conclusions: Using improvement methodology, we increased the proportion of patients seen in the ED/UC who received OCS in-hand at discharge from 2% to 96% without any increase in 7 day returns requiring additional OCS. This practice change within one division had a ripple effect across multiple care sites, including inpatient change to dexamethasone and a standardized process for outpatient follow-up. Future work will focus on standardization of key decisions across ED/UC in collaboration with all key stakeholders.Figure 1 Figure 2 Figure 3