Background and Purpose: Asthma education in acute care setting may prevent return visits. However, delivery of asthma education is time consuming and does not occur consistent in acute care areas. The objective of this Quality Improvement project was to implement efficient asthma education for patients discharged from Emergency Department and Urgent Care sites. Project Aim: Improve delivery of asthma discharge education in Emergency Departments (ED) and Urgent Care (UC) sites by achieving 90% utilization of asthma action plan and best practice checklist by March 2018. Methods: We included patients over 2 years of age with a primary diagnosis of asthma, who were treated and discharged from one of seven participating ED/UC sites. The primary outcome was asthma action plan delivery on discharge. Secondary outcome was completion of the best practice checklist during the visit. Balancing measure was ED/UC length of stay. DMAIC (Define, Measure, Analyze, Improve and Control) methodology was used. Multi-disciplinary team, including respiratory therapists, nurses and providers participated in Kaizen event. Stakeholders and content experts form inpatient, ambulatory and acute care sites were represented to identify key drivers for delivering efficient asthma education. Real time electronic dashboard was utilized for data collection and analysis. Interventions included a) implementing universal electronic medical record (EMR) based asthma action plan (AAP) smart form in acute care, inpatient and ambulatory areas; b) implementing EMR based best practice checklist; c) asthma education ordering and team communication standardization; e) multi-modal education; e) regular feedback to teams on site performance. Site champions were utilized for ongoing education and process audit. Statistical process control methodology was used to detect special cause variation in outcomes. Results: 3189 patients met inclusion criteria during project period (January 2017 to March 2018). Special cause variation was detected for percent of patients receiving asthma action plan on discharge (58% vs 79%) our primary outcome measure. Special cause variation was also seen for percent of patients with completed best practice checklist (0% to 79%). Average length of stay remained at 3.5 hours. Conclusion: Using QI methodology, we improved delivery of efficent asthma education in Emergency Departments and Urgent Care Sites. Multidisciplinary involvement and designated site champions were instrumental to project’s success. Future improvement efforts will be focused on utilizing best practice checklist for streamlining smoking cessation education and improving inhaled steroid prescribing in acute care setting.
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Section on Emergency Medicine| August 01 2019
Improving Delivery of Asthma Education in Pediatric Emergency Department and Urgent Care Sites
Irina Topoz, MD;
Paige Krack, MBA, MS;
Pediatrics (2019) 144 (2_MeetingAbstract): 428.
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Irina Topoz, Paige Krack, Joyce Baker; Improving Delivery of Asthma Education in Pediatric Emergency Department and Urgent Care Sites. Pediatrics August 2019; 144 (2_MeetingAbstract): 428. 10.1542/peds.144.2MA5.428
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