Improving inpatient cystic fibrosis pulmonary exacerbation care: two success stories. BMJ Qual Saf 2014 Apr;23 Suppl 1:i33-i41
Date
03/13/2014Pubmed ID
24608549DOI
10.1136/bmjqs-2013-002367Scopus ID
2-s2.0-84896535767 (requires institutional sign-in at Scopus site) 9 CitationsAbstract
BACKGROUND: Pulmonary exacerbations (PEx) in cystic fibrosis (CF) are a frequent cause of hospitalisations and lead to long-term decline in pulmonary function. Successful CF inpatient care requires the coordination of multiple providers and complex therapies. Children's Hospital of Wisconsin (CHW) and Children's Healthcare of Atlanta (CHoA) independently identified PEx inpatient care for focused improvements, with emphasis on improving care coordination and patient outcomes.
METHODS: Both centres began by forming multidisciplinary workgroups, including patient and family representatives. CHW's specific aim was to eliminate delays in the time to initial intravenous antibiotics. A written handoff tool was developed to allow more efficient ordering. Efforts at CHoA focused on coordination and consistent care delivery. A written schedule and patient incentive programme were devised to ensure proper administration of treatments and promote patient adherence.
RESULTS: At CHW, interventions decreased the mean antibiotic order time by 59% with resultant decrease in administration time by 25%. At CHoA, improvements led to a 42% decrease in the proportion of hospitalisations unsuccessful in returning lung function back to within 90% of baseline.
CONCLUSIONS: Inpatient CF PEx care is complex and requires multiple competing activities and treatments. Consistent and timely delivery of these treatments is challenging. Our improvements used the skills and insights of providers and patients to improve, standardise and synchronise care, and to develop tools to coordinate hand offs. With these improvements, applicable to hospital treatment of many other conditions, both centres were successfully able to deliver treatments in a more consistent and timely manner with improved outcomes.
Author List
Antos NJ, Quintero DR, Walsh-Kelly CM, Noe JE, Schechter MSAuthor
Nicholas Antos MD Associate Professor in the Pediatrics department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdolescentChild
Child, Preschool
Cystic Fibrosis
Disease Progression
Female
Georgia
Hospitalization
Hospitals, Pediatric
Humans
Inpatients
Interdisciplinary Communication
Lung Diseases
Male
Patient Care Team
Professional-Family Relations
Quality Assurance, Health Care
Quality Improvement
Risk Assessment
Wisconsin
