Patient Quality

Improved Effectiveness of Care

Use of Evidence-Based Guidelines

Since 1996, Cincinnati Children's Hospital Medical Center has targeted improving the effectiveness of care by developing family-centered, evidence-based clinical guidelines for common childhood conditions, including asthma and bronchiolitis. These guidelines help clinicians and families make health care decisions based on the best available evidence. They improve quality while reducing unnecessary variation in practice, unnecessary cost and unnecessary hospitalization.

Cincinnati Children's is a national leader in developing pediatric evidence-based guidelines for the most common conditions experienced, having produced more than 25. But we have learned that simply publishing guidelines is not enough. There must be effective systems for instituting their use by caregivers.

One successful approach at Cincinnati Children's was to embed our guidelines into easy-to-use order sets, which are the default setting in our computerized clinical order entry system. In addition, process improvement initiatives in the Emergency Department (ED) and on inpatient units have focused on creating care delivery systems that improve reliability of care and adherence to the guideline recommendations.

	July - September 2009
Evidence-based care provided: What percentage of condition specific evidence-based guidelines are practiced in the course of providing care? (Percentage of condition specific evidence-based guidelines followed in the emergency department and on inpatient units) View our performance over time. (.pdf)	92%

These efforts dramatically increased to nearly 100 percent the number of patients with asthma, bronchiolitis, community-acquired pneumonia, gastroenteritis and fever of uncertain source who receive evidence-based care during the ED visit or inpatient stay at Cincinnati Children's.

Preventing Hospitalization

An important goal of our evidence-based guidelines is preventing needless emergency and inpatient care. Adherence to the guideline recommendations by both hospital and community physicians improves the quality of care, avoids overuse of hospital resources, reduces health care costs and spares families the stress of hospitalization.

Community pediatricians are actively involved in developing our guidelines, often serving as leaders of the guideline team. The guidelines are routinely provided to community members of the hospital's Medical Staff and are posted on the Cincinnati Children's web site. In addition, care teams in the Emergency Department, inpatient units and physician offices, partnering with families, track patient outcomes and continuously improve the care.

Impact on Admissions and Average Length of Stay for Fiscal Year 1996 - Fiscal Year 2007
Condition	Admission	Average Length of Stay
Asthma	50% Decrease	30% Decrease
Bronchiolitis	29% Decrease	22% Decrease
Community-Acquired Pneumonia	12% Decrease	9% Decrease
Fever of Uncertain Source	71% Decrease	37% Decrease
Gastroenteritis	38% Decrease	12% Increase