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Original Articles

Multifaceted quality improvement initiative to decrease pediatric asthma readmissions

Nadia L KruppDepartment of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USACorrespondence[email protected]

, MD,

Cindy FiscusRiley Hospital for Children at Indiana University Health, Indianapolis, IN, USA

, RN, BSN,

Russell WebbRiley Hospital for Children at Indiana University Health, Indianapolis, IN, USA

, RRT,

Emily C WebberDepartment of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA;Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA

, MD,

Teresa StanleyRiley Hospital for Children at Indiana University Health, Indianapolis, IN, USA

, RN,

Rebecca PettitRiley Hospital for Children at Indiana University Health, Indianapolis, IN, USA

, PharmD,

Ashley DavisRiley Hospital for Children at Indiana University Health, Indianapolis, IN, USA

, RN,

Judy HollingsworthRiley Hospital for Children at Indiana University Health, Indianapolis, IN, USA

, RN,

Deborah BagleyRiley Hospital for Children at Indiana University Health, Indianapolis, IN, USA

, RN,

Marjorie McCaskeyRiley Hospital for Children at Indiana University Health, Indianapolis, IN, USA

, RN, DNP,

John C StevensDepartment of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA

, MD,

Andrea WeistDepartment of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA

, MD,

A Ioana CristeaDepartment of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA

, MD,

Heather WarhurstRiley Hospital for Children at Indiana University Health, Indianapolis, IN, USA

, PharmD,

Benjamin BauerDepartment of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA;Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA

, MD,

Michele SaysanaDepartment of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA

, MD,

Gregory S MontgomeryDepartment of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA

, MD,

Michelle S HowenstineDepartment of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA

, MD &

Stephanie D DavisDepartment of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA

, MD show all

ABSTRACT

Background: Asthma is the most common chronic disease of childhood and a leading cause of hospitalization in children. A primary goal of asthma control is prevention of hospitalizations. A hospital admission is the single strongest predictor of future hospital admissions for asthma. The 30-day asthma readmission rate at our institution was significantly higher than that of other hospitals in the Children's Hospital Association. As a result, a multifaceted quality improvement project was undertaken with the goal of reducing the 30-day inpatient asthma readmission rate by 50% within two years. Methods: Analysis of our institution's readmission patterns, value stream mapping of asthma admission, discharge, and follow-up processes, literature review, and examination of comparable successful programs around the United States were all utilized to identify potential targets for intervention. Interventions were implemented in a stepwise manner, and included increasing inhaler availability after discharge, modifying asthma education strategies, and providing in-home post-discharge follow-up. The primary outcome was a running 12-month average 30-day inpatient readmission rate. Secondary outcomes included process measures for individual interventions. Results: From a peak of 7.98% in January 2013, a steady decline to 1.65% was observed by July 2014, which represented a 79.3% reduction in 30-day readmissions. Conclusion: A significant decrease in hospital readmissions for pediatric asthma is possible, through comprehensive, multidisciplinary quality improvement that spans the continuum of care.

KEYWORDS:

Acknowledgements

The authors would like to acknowledge Greta Achenbach, RN; Mary Krespach, RRT; Young Jee Kim, MD; Erin Thompson, RN; Shonda Eaton, RRT; Gregory Hein, RRT; Andrew Stevens, MD; Elizabeth Weinstein, MD; and Jennifer Walthall, MD, MPH.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

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Multifaceted quality improvement initiative to decrease pediatric asthma readmissions

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Multifaceted quality improvement initiative to decrease pediatric asthma readmissions

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