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2 results on '"Bartlett KW"'

1. Initial Modified Pulmonary Index Score Predicts Hospital Length of Stay for Asthma Subjects Admitted to the Pediatric Intensive Care Unit.

Author

Miller AG, Haynes KE, Gates RM, Zimmerman KO, Bartlett KW, McLean HS, and Rehder KJ

Subjects
Adolescent, Child, Child, Preschool, Hospitals, Humans, Length of Stay, Retrospective Studies, Asthma therapy, Intensive Care Units, Pediatric
Abstract

Background: Scoring systems are frequently used to assess the severity of pediatric asthma exacerbations. The modified pulmonary index score (MPIS) has been found to be highly correlated with length of stay (LOS) in the pediatric intensive care unit (PICU). We sought to evaluate the use of the MPIS to predict hospital LOS for patients admitted to our PICU., Methods: We retrospectively reviewed the medical records of pediatric asthma subjects aged 2-17 y admitted to our PICU between June 2014 and November 2017. We divided subjects a priori into 3 groups (low: MPIS 0-5; medium: MPIS 6-9; high: MPIS ≥ 10) based upon each subject's first MPIS documented in the PICU. Hospital LOS, PICU LOS, time on continuous albuterol, and increased respiratory support were compared between groups., Results: 143 subjects were included. There were no differences for demographics, medical history, cause of exacerbations, or mean heart rate between groups. There were significant differences between groups for mean breathing frequency ( P < .001), [Formula: see text] ( P = .01), and [Formula: see text] ( P < .004). There were significant differences between groups for route of admission ( P = .02), high-flow nasal cannula use ( P < .001), and use of a helium-oxygen mixture ( P < .001). There were significant differences between groups for median hospital LOS (1.2 vs 2.3 vs 3.4 d, P < .001), PICU LOS (0.39 vs 1.3 vs 2 d, P < .001), and time on continuous albuterol (7.4 vs 20.6 vs 34.7 h, P < .001). After adjusting for demographics and medical history, the incidence risk ratio for hospital LOS was 2.09 for PICU admission for an MPIS of 6-9 and 2.68 for an MPIS ≥ 10 when compared to an MPIS < 6., Conclusions: The MPIS thresholds used in our pathway appropriately predicted LOS in our cohort of subjects with asthma admitted to the PICU. Higher MPIS was associated with increased hospital LOS, PICU LOS, and time on continuous albuterol., Competing Interests: Mr Miller has disclosed a relationship with Ventec Life Systems. The other authors have disclosed no conflicts of interest., (Copyright © 2020 by Daedalus Enterprises.)

Published
2020
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2. Improving the Efficiency of Care for Pediatric Patients Hospitalized With Asthma.

Author

Bartlett KW, Parente VM, Morales V, Hauser J, and McLean HS

Subjects
Adolescent, Child, Child, Preschool, Clinical Protocols standards, Efficiency, Organizational, Female, Hospital Costs statistics & numerical data, Hospitals, Pediatric statistics & numerical data, Humans, Interdisciplinary Communication, Length of Stay, Male, Medical Overuse prevention & control, North Carolina epidemiology, Outcome and Process Assessment, Health Care, Asthma diagnosis, Asthma economics, Asthma epidemiology, Asthma therapy, Critical Pathways standards, Patient Care Planning organization & administration, Patient Care Planning standards, Patient Readmission statistics & numerical data, Quality Improvement organization & administration
Abstract

Background: Asthma exacerbations are a leading cause of hospitalization among children. Despite the existence of national pediatric asthma guidelines, significant variation in care persists. At Duke Children's Hospital, we determined that our average length of stay (ALOS) and cost for pediatric asthma admissions exceeded that of our peers. Our aim was to reduce the ALOS of pediatric patients hospitalized with asthma from 2.9 days to 2.6 days within 12 months by implementing an asthma pathway within our new electronic health record., Methods: We convened a multidisciplinary committee charged with reducing variability in practice, ALOS, and cost of inpatient pediatric asthma care, while adhering to evidence-based guidelines. Interventions were tested through multiple "plan-do-study-act" cycles. Control charts of the ALOS were constructed and annotated with interventions, including testing of an asthma score, implementation of order sets, use of a respiratory therapy-driven albuterol treatment protocol, and provision of targeted education. Order set usage was audited as a process measure. Readmission rates were monitored as a balancing measure., Results: The ALOS of pediatric patients hospitalized with asthma decreased significantly from 2.9 days to 2.3 days. Comparing baseline with intervention variable direct cost data revealed a savings of $1543 per case. Improvements occurred in the context of high compliance with the asthma pathway order sets. Readmission rates remained stable throughout the study period., Conclusions: Implementation of an asthma care pathway based on the electronic health record improved the efficiency and variable direct costs of hospital care, reduced variability in practice, and ensured adherence to high-quality national guidelines., (Copyright © 2017 by the American Academy of Pediatrics.)

Published
2017
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