The Science Journal of the American Association for Respiratory Care

2012 OPEN FORUM Abstracts


Lisa Wright, Lynda Bennett, Jeff Bennett, Barbara Latham; Respiratory Therapy, UK HealthCare, Kentucky Children’s Hospital, Lexington, KY

Background: At Kentucky Children’s Hospital, completion of the Children’s Asthma Care (CAC) Home Management Plan of Care (HMPC) requires coordinated involvement among nurses, clerks, respiratory therapists and physicians. Historically, the respiratory therapist was responsible for HMPC delivery but perfection was repeatedly missed due to overlooked criteria. The respiratory therapist was often struggling at the time of discharge to get the clerk, nurse and physician to complete their piece of the process. Delays in discharge created a conflict that put perfect completion of the HMPC process at risk. Numerous small cycles of change were implemented over time. Indeed these changes did improve CAC compliance from < 50% to 70%. It was clear that reaching the overarching goal of 100% was going to require major process transformation. Method: A respiratory therapy led multi-disciplinary process improvement team was assembled to redesign standard work for children’s asthma. The team mapped out a process resulting in a complete HMPC within 24 hours of admission. Clinical decision support tools, such as electronic medical record (EMR) generated emails and clinical documentation alerts, were designed to initiate the process on admission and keep it flowing. The new process remains RT driven but engages all care providers earlier and more consistently through EMR alerts and visual cues. With the guidance of informatics, the team designed a simple electronic HMPC document that maps all pertinent information to a patient-friendly color Home Management Plan of Care report. Strategic hard stops were built in so the report cannot be generated until all team members have completed their role. Deliberate EMR alerts signal the need for process input at specified time points. Results: CAC compliance sustainably increased from 70% to 95% immediately following implementation of the transformed process. The revised process also positively impacted numerous other quality, safety, efficiency and patient/staff satisfaction domains (see table). Conclusion: By engaging the entire healthcare team and utilizing electronic tools, a respiratory therapy led multidisciplinary team boosted CAC Core measure compliance immediately and sustainably to well above the UHC average. The improved process also resulted in numerous advantages in quality, safety, efficiency and patient/staff satisfaction. Sponsored Research - None