Optimizing Inpatient Kawasaki Disease Care - A Quality Improvement Project to Reduce Length of Stay
Notice bibliographique
Résumé
Objectives Kawasaki Disease (KD), an acute pediatric vasculitis, requires timely inpatient management to prevent coronary artery disease.[1] The Hospital for Sick Children (SickKids) sees about 100 cases of KD annually. Hospitalization and lack of reliable educational resources negatively impact on the patient and family experience.[2,3] By eliminating inefficiencies, reducing length of stay (LOS) and improving patient education, we aim to optimize patient experience and conserve healthcare resources. The objective is to optimize inpatient care for uncomplicated KD by reducing LOS by 33% at SickKids by December 2024. Methods This is a quality improvement project using the Model for Improvement Framework. The project includes all patients diagnosed and treated at SickKids. Stakeholders include Pediatric Medicine, Rheumatology, KD clinic, Transfusion Medicine and parent representatives. The outcome measure is LOS. Outcome measurement excluded patients with: shock, prolonged antibiotics, IVIG-resistance and coronary artery lesions. Process and balancing measures were collected for all patients. Balancing measures included rate of re-presentation to emergency care, untreated fever and patient satisfaction. Cost savings were estimated by calculating reductions in hours of admission as well as unnecessary bloodwork. A chart review of 26 patients in 2023 demonstrated a baseline average LOS of 56 hours. A new clinical pathway was developed to standardize care and eliminate unnecessary testing. Updated educational materials for caregivers were developed. Patient satisfaction surveys collected anonymous feedback on the inpatient experience as a balancing measure and were compared to hospital-wide patient satisfaction data. Results Thirty-two patients were admitted with KD since implementation of change ideas in December 2023, with outcome measures collected for 15 patients. The average LOS was 48 hours (14% reduction from baseline) (Figure 1). Process measures among 32 patients showed excellent uptake in change ideas following 3 PDSA cycles. Patient satisfaction remained high and there were no increased rates of healthcare utilization or safety issues between discharge and first clinic follow-up. There was an estimated $14,725 in cost savings over 32 admissions. Conclusion Although a 14% reduction in LOS did not meet our target, there was a significant downward shift in LOS due to a strong uptake of the new KD clinical pathway. Adherence to the KD pathway was achieved through stakeholder engagement, standardization and use of automation. Cost and resource savings were achieved through reduction in LOS and unnecessary laboratory testing. Further data collection is required to demonstrate sustainability; however, this project and pathway may be of interest to other institutions that care for patients with KD. [1.] Money NM. Hosp Pediatr 2022;e2021006364. [2.] Robinson C. Paediatr Child Health 2022;27(3):160-8. [3.] Chahal N. J Pediatr Health Care Off Publ Natl Assoc Pediatr Nurse Assoc Pract 2010;24(4):250-7.
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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 | 0,019 | 0,016 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,002 | 0,001 |
| Science ouverte | 0,002 | 0,003 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 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 ».