Optimizing Inpatient Kawasaki Disease Care - A Quality Improvement Project to Reduce Length of Stay

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.

Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.