title: Improving inpatient cystic fibrosis pulmonary exacerbation care: two success stories.
abstract: BACKGROUND
  Pulmonary exacerbations (PEx) in cystic fibrosis (CF) are a frequent cause of hospitalisations and lead to long-term decline in pulmonary function. Successful CF inpatient care requires the coordination of multiple providers and complex therapies. Children's Hospital of Wisconsin (CHW) and Children's Healthcare of Atlanta (CHoA) independently identified PEx inpatient care for focused improvements, with emphasis on improving care coordination and patient outcomes.
  
  
  METHODS
  Both centres began by forming multidisciplinary workgroups, including patient and family representatives. CHW's specific aim was to eliminate delays in the time to initial intravenous antibiotics. A written handoff tool was developed to allow more efficient ordering. Efforts at CHoA focused on coordination and consistent care delivery. A written schedule and patient incentive programme were devised to ensure proper administration of treatments and promote patient adherence.
  
  
  RESULTS
  At CHW, interventions decreased the mean antibiotic order time by 59% with resultant decrease in administration time by 25%. At CHoA, improvements led to a 42% decrease in the proportion of hospitalisations unsuccessful in returning lung function back to within 90% of baseline.
  
  
  CONCLUSIONS
  Inpatient CF PEx care is complex and requires multiple competing activities and treatments. Consistent and timely delivery of these treatments is challenging. Our improvements used the skills and insights of providers and patients to improve, standardise and synchronise care, and to develop tools to coordinate hand offs. With these improvements, applicable to hospital treatment of many other conditions, both centres were successfully able to deliver treatments in a more consistent and timely manner with improved outcomes.
authors.affiliation: Division of Pulmonary and Sleep Medicine, Department of Pediatrics, Medical College of Wisconsin, Children's Hospital of Wisconsin, , Milwaukee, Wisconsin, USA.
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Antos
authors.forename: Diana R
authors.initials: DR
authors.lastname: Quintero
authors.forename: Christine M
authors.initials: CM
authors.lastname: Walsh-Kelly
authors.forename: Julie E
authors.initials: JE
authors.lastname: Noe
authors.forename: Michael S
authors.initials: MS
authors.lastname: Schechter
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003550:Cystic Fibrosis / Q000150:complications / Q000628:therapy*; D018450:Disease Progression; D005260:Female; D005845:Georgia; D006760:Hospitalization / Q000706:statistics & numerical data; D006776:Hospitals, Pediatric; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D033183:Interdisciplinary Communication; D008171:Lung Diseases / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D010348:Patient Care Team / Q000458:organization & administration*; D011368:Professional-Family Relations; D011785:Quality Assurance, Health Care; D058996:Quality Improvement; D018570:Risk Assessment; D014922:Wisconsin
keywords: Hospital Medicine; PDSA; Paediatrics; Quality Improvement; Team Training