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 BRONCHIOLITIS STANDING ADMIT ORDERS & CHEST RADIOGRAPHY UTILIZATION.

Kim Bennion BS RRT & Julie Ballard 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. The CPG includes a standing admit order sheet (SAO) designed for use by physicians for initial orders when pts are admitted. It was felt that utilizing an SAO might decrease unwarranted variations in ordering practices. If ordering outside the CPG criteria, physicians are asked to provide a brief explanation as to the reason(s). The SAO is annually updated in keeping with current evidence-based practice. Prior to the 2003-2004 season (Nov. 1-April 30), previous season outcomes were reviewed & goals for the 5 participating facilities were identified. Two of the goals were to decrease chest radiography (CXR) utilization in uncomplicated bronchiolitis pts, as this has not been shown to improve pt outcomes, and to increase SAO utilization. Education for the 5 participating hospital staffs (RT, nursing & medical staffs) was also provided.

Methods:
Data were extracted retrospectively from the hospitals’ data systems. Inclusion criteria were all pts from the 02-03 & 03-04 seasons < 2 years of age, admitted to 1 of the 5 participating IHC hospitals with any diagnosis of bronchiolitis. 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 Outcomes Comparing the 2002-2003 & 2003-2004 Seasons

Site Total Pts # (%) SAO Utilization # (%) CXR Utilization # (%)
  02-03 03-04 02-03 03-04 02-03 03-04
DR 45 133 41 (91) * 92 (69) 39 (87) 114 (86)
PC 499 844 408 (82) * 502 (59) 313 (63) 504 (60)
MK 122 246 No Data 197 (80) 83 (68) 165 (67)
AF 82 84 37 (45) 41 (49) 71 (87) 70 (83)
UV 158 179 77 (49) * 127 (71) 118 (75) * 113 (63)

*Denotes a statistically significant change either improved or worsened (P < 0.05)


Discussion:
SAO utilization is probably worse or unchanged & CXR utilization virtually unchanged at most facilities probably due to a lack of auditing with timely feedback to physicians. Administrators at each hospital will be presented these data with emphasis placed on the need for their support in improving our outcomes. The impact of reporting reliable outcomes to identify areas for process improvement coupled with education to improve clinical practice cannot be over emphasized. The success in standardizing, gathering, extracting, analysing & reporting of outcomes within the 5 facilities is worth noting. Improvements can take 2-3 years to appreciate once outcomes are reported & changes are implemented. 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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