title: The Effect of Implementation of Standardized, Evidence-Based Order Sets on Efficiency and Quality Measures for Pediatric Respiratory Illnesses in a Community Hospital.
abstract: OBJECTIVE
  Standardization of evidence-based care, resource utilization, and cost efficiency are commonly used metrics to measure inpatient clinical care delivery. The aim of our project was to evaluate the effect of pediatric respiratory order sets and an asthma pathway on the efficiency and quality measures of pediatric patients treated with respiratory illnesses in an adult community hospital setting.
  
  
  METHODS
  We used a pre-post study to review pediatric patients admitted to the inpatient setting with the primary diagnoses of asthma, bronchiolitis, or pneumonia. Patients with concomitant chronic respiratory illnesses were excluded. After implementation of order sets and asthma pathway, we examined changes in respiratory medication use, hospital utilization cost, length of stay (LOS), and 30-day readmission rate. Statistical significance was measured via 2-tailed t-test and Fisher test.
  
  
  RESULTS
  After implementation of evidence-based order sets and asthma pathway, utilization of bronchodilators decreased and the hospital utilization cost of patients with asthma was reduced from $2010 per patient in 2009 to $1174 per patient in 2011 (P < .05). Asthma LOS decreased from 1.90 days to 1.45 days (P < .05), bronchiolitis LOS decreased from 2.37 days to 2.04 days (P < .05), and pneumonia LOS decreased from 2.3 days to 2.1 days (P = .083). Readmission rates were unchanged.
  
  
  CONCLUSIONS
  The use of order sets and an asthma pathway was associated with a reduction in respiratory treatment use as well as hospitalization utilization costs. Statistically significant decrease in LOS was achieved within the asthma and bronchiolitis populations but not in the pneumonia population. No statistically significant effect was found on the 30-day readmission rates.
authors.affiliation: Division of Hospitalist Medicine, Children's National Medical Center, Washington, District of Columbia; George Washington University School of Medicine Department of Pediatrics, Washington, District of Columbia; and Mary Washington Hospital, Department of Pediatric Hospitalist Medicine, Fredericksburg, Virginia adayal@childrensnational.org.
authors.forename: Anuradha
authors.initials: A
authors.lastname: Dayal
authors.affiliation: Division of Hospitalist Medicine, Children's National Medical Center, Washington, District of Columbia; George Washington University School of Medicine Department of Pediatrics, Washington, District of Columbia; and Mary Washington Hospital, Department of Pediatric Hospitalist Medicine, Fredericksburg, Virginia.
authors.forename: Francisco
authors.initials: F
authors.lastname: Alvarez
mesh_terms: D000293:Adolescent; D001249:Asthma / Q000628:therapy*; D001988:Bronchiolitis / Q000628:therapy*; D001993:Bronchodilator Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D065187:Controlled Before-After Studies; D019091:Critical Pathways; D017721:Hospital Costs; D006760:Hospitalization / Q000191:economics; D006764:Hospitals, Community; D006801:Humans; D007223:Infant; D011014:Pneumonia / Q000628:therapy*; D011785:Quality Assurance, Health Care; D012189:Retrospective Studies
chemical_list: D001993:Bronchodilator Agents