Clinical Vasculitis Fellow The Hospital for Sick Children Toronto, Ontario, Canada
Background: Kawasaki disease (KD) is an acute childhood vasculitis affecting 19.6-22.2 per 100,000 children in Canada. KD varies seasonally and is frequently associated with viral infection – leading to increased hospitalization rates coinciding with peak respiratory virus season. Hospitalization is often traumatic for these children and there are high rates of parental anxiety following diagnosis. Parents want reliable educational resources with information about expected symptoms following discharge. Lastly, families spend >24 hours after IVIG infusion awaiting tests and fever recurrence – leading to increased healthcare costs and poor use of beds. By reducing length of stay (LOS) through eliminating inefficiencies and optimizing patient experience, we could decrease families’ exposure to nosocomial infections and iatrogenic complications while improving hospital resource utilization. Objective: Optimize care for uncomplicated Kawasaki disease by reducing length of stay by 33% at the Hospital for Sick Children by April 2024. Design/Methods: The project was approved by Quality Management at SickKids and includes stable, admitted patients diagnosed with KD and treated with IVIG and aspirin. Exclusion criteria are: age < 1 year, fever >10 days, instability at presentation and a concurrent condition requiring increased LOS. Stakeholders include Paediatric Medicine, Rheumatology, Cardiology, the blood bank and parent representatives. Baseline data review of 9 patients demonstrated an average LOS of 56 hours. Root cause analysis included review of a process map outlining patients' flow from admission to discharge. Change ideas to be tested through PDSAs include the development of patient education materials, streamlining workflow and eliminating unnecessary tests. LOS is the main outcome measure. Balancing measures include repeat visits to ED after discharge and rate of untreated fever. About 36 patients will be included to establish a baseline and to test rapid change cycles. Statistical process control charts will be used to identify significant change.
