The Science Journal of the American Association for Respiratory Care

2010 OPEN FORUM Abstracts


Jeffrey Gardner, Samantha Rooks, Chris Lynn, Cheryl Burney-Jones; Pediatric Respiratory Care, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, TN

BACKGROUND: Respiratory distress is a common complaint in pediatric emergency medicine. This complaint accounted for 2,061 patients, 7% of total patient volumes from June to December 2009, in the pediatric emergency department (PED) at Monroe Carell Jr. Children’s Hospital at Vanderbilt (MCJCHV). Considering the National Heart Lung and Blood Institute guidelines to reach a disposition on moderate to severe asthmatics within 4-6 hours of presentation to the PED, the respiratory department at MCJCHV made hourly scoring of patients with mild to severe respiratory distress a goal. The long term goal is to decrease length of stay by increasing frequency of assessment and communication of therapist recommendations to the physician group. An adaptation of Qureshi’s scoring system (NEJM 1998) was utilized, which assigns severity scores from 0 to 3 in five areas. All scoring was documented by the therapist in the electronic medical record. DATA: Patients with a total respiratory distress score (RDS) > 5 were tracked for the first four hours or until discharge from the PED. Any RDS assigned later than one hour and fifteen minutes from the previous score was considered missed. Chart audits for Quarter 3 of 2009 revealed a 29% hourly scoring compliance. METHODS: Steps were taken to increase hourly scoring compliance to a goal of 80%. PED staffing was increased to have two therapists per shift to cover a 35 bed emergency unit. Staff were educated on the importance and goal of the initiative. The current electronic charting system was evaluated to ensure barriers to provide hourly scoring were addressed. Progress was communicated through multiple streams such as daily pre-shift huddles, electronic communications and staff meetings. Finally, individual staff compliance was addressed to reach the department goal. RESULTS: As of May 2010, continued efforts have improved hourly scoring compliance to 83%. CONCLUSIONS: Improving frequency of patient assessment can be accomplished by following a dedicated staffing model and providing ongoing staff education and feedback. Future plans include assessing the impact of hourly scoring on patient throughput. Sponsored Research - None