The Science Journal of the American Association for Respiratory Care

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.

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