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. 2023 Aug;60(8):1573-1583.
doi: 10.1080/02770903.2022.2162412. Epub 2023 Feb 8.

Effects of a QI intervention on pediatric asthma treatment using patient outcomes and workflow in an emergency department

Mustafa Ozkaynak  1 , Claudia R Amura  1 , Marion R Sills  2 , Irina Topoz  2
Affiliations

Effects of a QI intervention on pediatric asthma treatment using patient outcomes and workflow in an emergency department

Mustafa Ozkaynak et al. J Asthma. 2023 Aug.

Abstract

Objective: Evaluate a nurse-initiated quality improvement (QI) intervention aimed at enhancing asthma treatment in a pediatric emergency department (ED), utilizing outcomes and workflow.

Methods: We evaluated the impact of QI interventions for pediatric patients presenting to the ED with asthma with pre-post analysis. A pediatric asthma score (PAS) of >8 indicated moderate to severe asthma. This secondary analysis of the electronic health record (EHR), evaluated on 1) patient outcomes (time to clinical treatment, ED length of stay [EDLOS], admissions and discharges home), 2) clinical workflow.

Results: We compared 886 visits occurring between 01/01/2015 and 09/27/2015 (pre-implementation period) with 752 visits between 01/01/2016 and 09/27/2016 (post-implementation). Time to first documentation of PAS was decreased post-intervention (p<.001) by >30 min (75 ± 57 to 39 ± 54 min). There were significant decreases in time to treatment with both steroid and bronchodilator administration (both p<.001). EDLOS did not significantly change. Based on acuity level, those discharged home from the ED with high acuity (PAS score ≥8), had a significant decrease in time to initial PAS, steroid and bronchodilator use and EDLOS. Of those with high acuity who were admitted to the hospital, there was a difference pre- to post-implementation, in time to first PAS (p<.05), but not to treatment. Workflow visualization provided additional insights and detailed (task level) comparisons of the timing of ED activities.

Conclusions: Nurse-initiated ED interventions, can significantly improve the timeliness of pediatric asthma evaluation and treatment. Examining workflow along with the outcomes, can better inform QI evaluations and clinical management.

Keywords: EHR data; PAS; Pediatric; asthma; emergency department; quality; visualization.

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Conflict of interest statement

Declaration of Interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.
Example of Eventflow diagram displaying three events.
Figure 2.
Figure 2.
Pre- (upper figure) and post- (lower figure) intervention workflow for discharged patients whose first PAS≥8
Figure 3.
Figure 3.
Pre- (upper figure) and post- (lower figure) intervention workflow for admitted patients whose first PAS < 8.
See this image and copyright information in PMC

References

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    1. Ozkaynak M, Dziadkowiec O, Mistry R, et al. Characterizing workflow for pediatric asthma patients in emergency departments using electronic health records. J Biomed Inform. Oct 2015;57:386–98. doi:10.1016/j.jbi.2015.08.018 - DOI - PubMed
    1. Ozkaynak M, Unertl KM, Johnson SA, Brixey JJ, Haque SN. Clinical Workflow Analysis, Process Redesign, and Quality Improvement. In: Finnel J, Dixon B, eds. Clinical Informatics Study Guide. Springer International Publishing; 2016:135–161.
    1. Ozkaynak M, Reeder B, Drake C, Ferrarone P, Trautner B, Wald H. Characterizing Workflow to Inform Clinical Decision Support Systems in Nursing Homes. The Gerontologist. 2019;59(6):1024–1033. - PubMed
    1. Ozkaynak M, Wu DTY, Hannah K, Dayan PS, Mistry RD. Examining workflow in a pediatric emergency department to develop a clinical decision support for an antimicrobial stewardship program. Applied Clinical Informatics. 2018;9(2):248–260. - PMC - PubMed

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