PARTNERING OF A FRONTLINE HEALTHCARE TEAM WITH A FAMILY ADVISOR TO IMPROVE ACUTE ASTHMA CARE IN A PEDIATRIC EMERGENCY DEPARTMENT: COST SAVINGS ANALYSIS
Bibliographic record
Abstract
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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.010 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.003 |
| Bibliometrics | 0.003 | 0.002 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.007 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".