100. REDUCING PEDIATRIC ASTHMA HOSPITAL LENGTH OF STAY THROUGH A MULTIDISCIPLINARY CARE PATHWAY

Abstract

Background Asthma exacerbations are the 3rd most common cause of pediatric hospitalizations and account for 4% of pediatric admissions at Kaiser Permanente Oakland Medical Center (KPOMC). Average length of stay for asthmatics on the pediatric ward at KPOMC has historically been longer than that of other Tertiary Pediatric Care Facilities within the Kaiser Permanente Northern California Network. Aim Statement Our objective was to decrease length of stay after a year of implementing a multidisciplinary asthma care pathway using a standardized respiratory severity score integrated into our electronic medical records (EMR) system. Interventions As a multidisciplinary team we used an A3 problem solving approach and performed a root cause analysis to identify causes of increased length of stay for our asthmatic patients. Our team included pediatric hospitalists, intensivists, residents, nurses, respiratory therapists, pharmacists, and physical therapists. We performed a literature review and compared other pediatric hospital respiratory severity scores prior to selecting the Pediatric Assessment Score (PAS), a respiratory score already integrated into the KP Health Connect EMR. A standardized asthma care pathway was developed based upon frequent PAS measurements to determine medication weaning and escalation. It also incorporated appropriate timing for inhaled and systemic corticosteroids, mobility, and asthma education. Order panels were distributed among residents and hospitalists to promote adherence to the pathway. Prior to implementation, we completed an education campaign targeting nurses, respiratory therapists, and physicians. Measures Our primary outcome is length of stay and process measures include difference in time patients spent on continuous albuterol, rates of appropriate systemic steroids use, and use of metered dose inhalers. We will also review appropriate use of PAS according to the asthma care pathway. Our balance measure will be readmission rates at 7 days and at 30 days after discharge. Results Initial data showed a decrease in average length of stay from 2.93 days to 1.69 days without an increase in readmission rates at 7 days and at 30 days. Conclusions and Next Steps At KPOMC we saw a decrease in length of stay after implementing a multidisciplinary asthma care pathway that uses a respiratory severity score and order panels integrated into the EMR system. Next steps are “Plan, Do, Study, Act” (PDSA) cycles based on continued monitoring of length of stay and process measures.