Development of a Standardized Clinical Assessment and Management Plan for Pediatric Acute Respiratory Distress Syndrome

Abstract

Pediatric acute respiratory distress syndrome (PARDS) is one of the most challenging patient populations for a clinician to manage with mortality between 8 and 31%. The project was designed to identify patients with PARDS, implement management guidelines with the goal of standardizing practice. Our objectives were to describe the development and implementation of a protocolized approach to identify patients with PARDS and institute ventilator management guidelines. Patients who met criteria for moderate or severe PARDS as per the Pediatric Acute Lung Injury Consensus Conference (PALICC) definitions were identified using the best practice alert (BPA) in the electronic health record (EHR). Patients who did not meet exclusion criteria qualified for management using the Standardized Clinical Assessment and Management Plan (SCAMP), a quality improvement (QI) methodology with iterative cycles. The creation of a BPA enabled identification of patients with PARDS. With our second cycle, the number of false BPA alerts due to incorrect data decreased from 66.7 (68/102) to 29.2% (19/65; p < 0.001) and enrollment increased from 48.3 (14/29) to 73.2% (30/41; p = 0.03). Evaluation of our statistical process control chart (SPC) demonstrated a shift in the adherence with the tidal volume guideline. Overall, we found that SCAMP methodology, when used in the development of institutional PARDS management guidelines, allows for development of a process to aid identification of patients and monitor adherence to management guidelines. This should eventually allow assessment of impact of deviations from clinical practice guidelines.

Leveraging Clinical Informatics and Data Science to Improve Care and Facilitate Research in Pediatric Acute Respiratory Distress Syndrome: From the Second Pediatric Acute Lung Injury Consensus Conference

“…Earlier and more accurate identification of patients with PARDS can result in higher adherence to clinical best practices (15) .…”

“…Automated screening and prompting systems can promote adherence to clinical guidelines (15) . However, bedside clinicians often suffer alert fatigue in the critical care settings, and excessive alert burden may have negative effects (16) .…”

“…The adult studies include one quasi-experimental study and one RCT (with a combined 337 patients receiving the intervention and 220 controls in both studies) ( 21, 22 ). The pediatric studies included three quasi-experimental studies (with 143 patients receiving the intervention and 258 controls) ( 15, 23, 24 ). In both the adult and pediatric studies, evidence shows that automatic compliance monitoring and feedback to clinicians resulted in greater adherence to recommended best practices in the intervention patients when compared with controls.…”