PARTNERING OF A FRONTLINE HEALTHCARE TEAM WITH A FAMILY ADVISOR TO IMPROVE ACUTE ASTHMA CARE IN A PEDIATRIC EMERGENCY DEPARTMENT: COST SAVINGS ANALYSIS
Notice bibliographique
Résumé
Abstract BACKGROUND In 2016, a Canadian paediatric emergency department (ED) partnered with families in the co-design of a LEAN-based quality improvement (QI) project with the goal of increasing the proportion of asthmatic children receiving oral corticosteroids within one hour of arrival. LEAN projects aim to eliminate non-value-added process steps and to creatively solve problems as a team. Implemented changes included a process redesign with steroids given at the door and a revised asthma pathway increasing nurse autonomy prior to physician assessment. A sustained improvement (>12 months) was achieved, with asthmatic children consistently (>90%) receiving timely steroids within a mean time of 20 minutes. OBJECTIVES The objective of this study was to determine the cost savings of the improvements achieved by eliminating non-value-added process steps executed by physicians and nurses. The primary outcome measure was the number of documented care acts by physicians and nurses. DESIGN/METHODS Cases were identified by using the diagnostic code for asthma in the electronic medical record. This study included children 1 to 18 with Pediatric Respiratory Assessment Measure (PRAM) score ≥ 4 at triage. Patients who required admission were excluded. We reviewed a random sample of 20 to 30 charts monthly for 12 months, 6 months pre- and post-implementation of the revised asthma pathway. Physicians are remunerated on a fee-for-service basis and we modeled cost-savings of physician remunerations based on publically available physician fees. We assessed the number of documented nursing acts as a proxy for resource allocation in the ED given that the pathway increased nursing autonomy prior to physician assessment. RESULTS A total of 270 patients were included. With a simple process redesign aimed at getting children timely steroids at triage, the number of physician assessments decreased by 18%. In terms of physician billing, the cost savings were $24 per asthmatic patient in the ED. With >3000 asthma ED visits annually, the resulting estimated cost savings were >$72,000 per year. Even though increased nursing autonomy was part of the new process, documented nursing acts decreased by 10%. Moreover, although not included in the cost savings analysis, ED length of stay and admission rates both decreased. CONCLUSION Engaging frontline healthcare teams to co-design improvement initiatives with family partners in the ED is an excellent mechanism for leaders to sponsor. Frontline teams can implement creative and simple solutions that result in improved quality of care while also reducing unnecessary healthcare expenditures.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,004 | 0,010 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,003 |
| Bibliométrie | 0,003 | 0,002 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,002 | 0,001 |
| Science ouverte | 0,002 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,007 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».