2004 OPEN FORUM Abstracts
OUTCOME UTILIZATION IN IDENTIFYING PROCESS IMPROVEMENT OPPORTUNITIES & THE EFFECTS OF AN EDUCATIONAL PROGRAM ON SUCTIONING IN THE TREATMENT OF BRONCHIOLITIS PATIENTS.
Julie Ballard BS RRT & Kim
Bennion BS RRT, Primary Children’s Medical Center, Salt Lake
City, Utah.
Introduction: The Intermountain Health Care
Corporation (IHC) owns & operates 22 acute care facilities in the
intermountain west. An IHC Bronchiolitis Committee was formed to
oversee the standardization of care for bronchiolitis inpatients
(pt). The committee is chaired by a respiratory therapist (RT) &
is comprised of RTs, RT department directors, medical directors,
nursing educators and a nurse administrator. The Bronchiolitis
Clinical Practice Guideline (CPG) had been used at one facility for 7
years and had been introduced to the other participating facilities.
After reviewing the outcomes from two previous seasons (Nov. 1-April
30), goals for the 2003-2004 season for the 5 participating
facilities were defined & included: (1) increase the number of
pts suctioned (NPS) before albuterol trials on the floor, (2)
decrease the time from admit to initial NPS & (3) increase the
number of pts suctioned during hospital admission. Education for the
staff (RT, nursing & medical staff) included but was not limited
to: (1) standardization of nasopharyngeal suctioning (NPS) with a
catheter, (2) review of bronchiolitis evidence-based practice &
(3) a reporting of the previous season
outcomes.
Methods: Data were extracted retro-spectively from
the hospital data systems. Initial inclusion criteria were all pts
with any diagnosis of bronchiolitis from the 02-03 & 03-04
seasons, < 2 years of age and admitted to 1 of the 5 participating
IHC hospitals with criteria further refined by the categories to be
studied. The assessment of NPS prior to albuterol trials included all
albuterol trials after admit to the floor. All admitted bronchiolitis
pts were included in the mean time from admit to initial NPS as well
as the percent of pts who were suctioned during their stay. Goals
were considered accomplished if a statistically significant
improvement was noted (P < 0.05).
Results: Statistical
analysis included T-test for continuous data and Fisher Exact Test
for nominal data. All hospital outcomes are reported in Table One.
Table One: All Hospital NPS Outcomes Comparing
the 2002-2003 & 2003-2004 Seasons
| Site | Total # Pts | % NPS Before Albuterol Trials | Mean Time (hrs) Admit to Initial NPS | % Pts NPS During Stay |
| 02-03 03-04 | 02-03 03-04 | 02-03 03-04 | 02-03 03-04 | |
| DR | 45 133 | 81 79 | 11.6 10.2 | 93 91 |
| PC | 499 844 | 68 * 56 | 19.2 * 5.7 | 89 91 |
| MK | 122 246 | 75 * 95 | 3.9 * 2.2 | 44 * 99 |
| AF | 82 84 | 28 45 | 7.5 6.3 | 76 * 88 |
| UV | 158 179 | 68 70 | 9.6 * 4.2 | 78 * 95 |
*Denotes a
statistically significant change either improved or worsened (P <
0.05)
Discussion: The impact of reporting
outcomes to identify areas for process improvement as well as
education to improve clinical practice cannot be over emphasized.
Improvements can take 2-3 years to appreciate once outcomes are
reported & changes are implemented. Given the number of areas
improved with statistical significance in NPS outcomes only 1 season
after the reporting & education, it is our impression that the
time & cost for the program were well spent. Many hospital data
systems do not allow for such detailed reporting. Attention should be
paid to this fact if our profession is to be considered outcomes
driven and thus evidence-based.