title: Implementation of Postoperative Respiratory Care for Pediatric Orthopedic Patients.
abstract: OBJECTIVE
  At our institution, one-fifth of pediatric patients undergoing hip and spine surgery require prolonged oxygen supplementation, most likely due to postoperative atelectasis. Using quality improvement methodology, we aimed to implement an innovative postoperative respiratory care algorithm for hip and spine surgery patients, with a global aim of improving respiratory outcomes.
  
  
  METHODS
  A multidisciplinary team developed a care algorithm that relied on an activated respiratory therapist (RT) and engagement of patients and families. The algorithm was implemented via multiple rapid tests of change. Process measures representing the beginning and end of the care algorithm were plotted on standard run charts. We evaluated the association of algorithm implementation with a primary outcome of prolonged (>10 hours) oxygen supplementation via a quasi-experimental design using Fisher's exact and t tests.
  
  
  RESULTS
  The team successfully implemented the algorithm, with a reliability to process of 80%. Key interventions included education of RTs, a daily huddle, and implementation of automated orders. Among all hip and spine patients, algorithm implementation was associated with a small, non-statistically significant decrease in prolonged oxygen use (21% to 16%). Among patients with underlying chronic conditions, there was a significant decrease in prolonged oxygen use from 22% to 6% after algorithm implementation (P = .04).
  
  
  CONCLUSIONS
  We implemented an innovative respiratory care algorithm in hip and spine surgery patients by empowering RTs and engaging families to participate in care. We found that this approach was associated with decreased prolonged oxygen use in patients with chronic underlying conditions.
authors.affiliation: Divisions of Hospital Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio erin.shaughnessy@cchmc.org.
authors.forename: Erin E
authors.initials: EE
authors.lastname: Shaughnessy
authors.affiliation: Respiratory Therapy.
authors.forename: Cynthia
authors.initials: C
authors.lastname: White
authors.affiliation: Divisions of Hospital Medicine.
authors.forename: Samir S
authors.initials: SS
authors.lastname: Shah
authors.affiliation: Divisions of Hospital Medicine.
authors.forename: Brittany
authors.initials: B
authors.lastname: Hubbell
authors.affiliation: University of Cincinnati College of Medicine, Cincinnati, Ohio Biostatistics and Epidemiology, and.
authors.forename: Heidi
authors.initials: H
authors.lastname: Sucharew
authors.affiliation: University of Cincinnati College of Medicine, Cincinnati, Ohio Pulmonology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; and.
authors.forename: Hemant
authors.initials: H
authors.lastname: Sawnani
mesh_terms: D000465:Algorithms; D002648:Child; D005260:Female; D006621:Hip Joint / Q000601:surgery*; D006801:Humans; D008297:Male; D019637:Orthopedic Procedures; D011182:Postoperative Care; D012138:Respiratory Therapy; D013131:Spine / Q000601:surgery*