BACKGROUND: Standardized pediatric asthma care has been shown to improve measures in specific hospital areas, but to our knowledge, the implementation of an asthma clinical practice guideline (CPG) has not been demonstrated to be associated with improved hospital-wide outcomes. We sought to implement and refine a pediatric asthma CPG to improve outcomes and throughput for the emergency department (ED), inpatient care, and the ICU. METHODS: An urban, quaternary-care childrena??s hospital developed and implemented an evidence-based, pediatric asthma CPG to standardize care from ED arrival through discharge for all primary diagnosis asthma encounters for patients a?￥2 years old without a complex chronic condition. Primary outcomes included ED and inpatient length of stay (LOS), percent ED encounters requiring admission, percent admissions requiring ICU care, and total charges. Balancing measures included the number of asthma discharges between all-cause 30-day readmissions after asthma discharges and asthma relapse within 72 hours. Statistical process control charts were used to monitor and analyze outcomes. RESULTS: Analyses included 3650 and 3467 encounters 2 years pre- and postimplementation, respectively. Postimplementation, reductions were seen in ED LOS for treat-and-release patients (3.9 hours vs 3.3 hours), hospital LOS (1.5 days vs 1.3 days), ED encounters requiring admission (23.5% vs 18.8%), admissions requiring ICU (23.0% vs 13.2%), and total charges ($4457 vs $3651). Guideline implementation was not associated with changes in balancing measures. CONCLUSIONS: The hospital-wide standardization of a pediatric asthma CPG across hospital units can safely reduce overall hospital resource intensity by reducing LOS, admissions, ICU services, and charges.
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机译：背景：已经证明标准化的儿科哮喘护理可以改善特定医院区域的措施，但是据我们所知，哮喘临床实践指南（CPG）的实施尚未证明与改善全院结局有关。我们寻求实施和完善小儿哮喘CPG，以提高急诊科（ED），住院护理和ICU的结局和通量。方法：城市四级保健儿童医院开发并实施了循证小儿哮喘CPG，以规范从ED到出院从ED出院到2岁以下且无复杂慢性病的所有初诊哮喘患者的护理。健康）状况。主要结局包括急诊室和住院时间（LOS），急诊室入院率，入院率，需要ICU护理的住院率和总费用。平衡措施包括哮喘出院后全天30天再入院与72小时内哮喘复发之间的哮喘出院数。统计过程控制图用于监视和分析结果。结果：分析分别包括实施前后2年的3650次和3467次遭遇。实施后，治疗和释放患者的ED LOS降低（3.9小时比3.3小时），医院LOS（1.5天比1.3天），ED患者需要入院（23.5％vs 18.8％），需要ICU的入院（23.0） ％vs 13.2％），以及总费用（$ 4457 vs $ 3651）。准则的执行与平衡措施的改变无关。结论：跨医院单位的全院儿科哮喘CPG的标准化可以通过减少LOS，住院，ICU服务和收费来安全地降低整体医院资源强度。
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