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The Outpatient Respiratory Care of Children with Sickle Cell Disease: A Quality Improvement Initiative
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A2064 - The Outpatient Respiratory Care of Children with Sickle Cell Disease: A Quality Improvement Initiative
Author Block: H. Mohsin1, A. Adeleye1, K. Kam1, A. Ruzycki2, M. Leaker2, G. N. Bendiak1; 1Section of Respiratory Medicine, Department of Pediatrics, Alberta Children's Hospital, Calgary, AB, Canada, 2Section of Hematology, Department of Pediatrics, Alberta Children's Hospital, Calgary, AB, Canada.
RATIONALE: Pulmonary complications are the leading cause of morbidity and mortality in children with sickle cell disease (SCD), and although common, they remain underdiagnosed by physicians. A consensus statement on the care of patients with SCD was released in 2015 by the Canadian Hemoglobinopathy Association, which identified several key respiratory parameters in the management of this patient population. We undertook a quality initiative to assess our clinic’s adherence to the guidelines.
METHODS: A retrospective electronic chart review was completed. All children diagnosed with SCD followed in the Hemoglobinopathy Clinic at Alberta Children’s Hospital between 2011 and 2016 were eligible for the study. Patients who underwent bone marrow transplantation, or transitioned to adult care during the study period, were excluded. Clinic notes were reviewed to obtain demographics, medication use, respiratory symptoms/diagnoses, obstructive sleep apnea (OSA) symptoms, and oxygen saturation measurements. Reports of completed pulmonary function testing (PFT) and screening echocardiogram were identified.
RESULTS: In total, 97 patients were eligible. Chart review was completed for 71 patients with review of 439 clinic notes. Mean (±SD) age of the patients at time of study was 6.6±3.3 years old. Thirty one (44%) were male. Sixty (85%) were SCD genotype hemoglobin SS. Fourteen (20%) had prior acute chest syndrome. Five (7%) had a pulmonologist diagnosis of asthma, with an additional 5 (7%) having a suspected diagnosis of asthma. Seven (10%) were on regular asthma therapies, including inhaled corticosteroids and montelukast.
In 2011, 9/22 (41%) of clinic encounters included documentation of respiratory and OSA symptoms. Measurements of oxygen saturation were recorded in 12/22 (55%) of visits. In the final year reviewed, 92/134 (68%) of clinic encounters included documentation of respiratory symptoms, with OSA symptoms recorded in 61/134 (45%). Measurements of oxygen saturation were recorded in 111/134 (83%) of visits. The percentage of PFT performed annually by eligible patients (≥ 6 years of age) increased from 1/8 (12.5%) in 2011 to 19/38 (50%) in 2016. Over the study period, 31/62 (50%) of eligible patients (≥ 3 years of age) completed screening echocardiogram.
CONCLUSIONS: Over the period of study, the total number of clinic encounters markedly increased. The frequency of documentation of key respiratory parameters in SCD also increased, as have rates of completion of essential clinical screening tests, although target rates of completion have not yet been reached. Factors underlying these changes with time will be further explored.
Author Block: H. Mohsin1, A. Adeleye1, K. Kam1, A. Ruzycki2, M. Leaker2, G. N. Bendiak1; 1Section of Respiratory Medicine, Department of Pediatrics, Alberta Children's Hospital, Calgary, AB, Canada, 2Section of Hematology, Department of Pediatrics, Alberta Children's Hospital, Calgary, AB, Canada.
RATIONALE: Pulmonary complications are the leading cause of morbidity and mortality in children with sickle cell disease (SCD), and although common, they remain underdiagnosed by physicians. A consensus statement on the care of patients with SCD was released in 2015 by the Canadian Hemoglobinopathy Association, which identified several key respiratory parameters in the management of this patient population. We undertook a quality initiative to assess our clinic’s adherence to the guidelines.
METHODS: A retrospective electronic chart review was completed. All children diagnosed with SCD followed in the Hemoglobinopathy Clinic at Alberta Children’s Hospital between 2011 and 2016 were eligible for the study. Patients who underwent bone marrow transplantation, or transitioned to adult care during the study period, were excluded. Clinic notes were reviewed to obtain demographics, medication use, respiratory symptoms/diagnoses, obstructive sleep apnea (OSA) symptoms, and oxygen saturation measurements. Reports of completed pulmonary function testing (PFT) and screening echocardiogram were identified.
RESULTS: In total, 97 patients were eligible. Chart review was completed for 71 patients with review of 439 clinic notes. Mean (±SD) age of the patients at time of study was 6.6±3.3 years old. Thirty one (44%) were male. Sixty (85%) were SCD genotype hemoglobin SS. Fourteen (20%) had prior acute chest syndrome. Five (7%) had a pulmonologist diagnosis of asthma, with an additional 5 (7%) having a suspected diagnosis of asthma. Seven (10%) were on regular asthma therapies, including inhaled corticosteroids and montelukast.
In 2011, 9/22 (41%) of clinic encounters included documentation of respiratory and OSA symptoms. Measurements of oxygen saturation were recorded in 12/22 (55%) of visits. In the final year reviewed, 92/134 (68%) of clinic encounters included documentation of respiratory symptoms, with OSA symptoms recorded in 61/134 (45%). Measurements of oxygen saturation were recorded in 111/134 (83%) of visits. The percentage of PFT performed annually by eligible patients (≥ 6 years of age) increased from 1/8 (12.5%) in 2011 to 19/38 (50%) in 2016. Over the study period, 31/62 (50%) of eligible patients (≥ 3 years of age) completed screening echocardiogram.
CONCLUSIONS: Over the period of study, the total number of clinic encounters markedly increased. The frequency of documentation of key respiratory parameters in SCD also increased, as have rates of completion of essential clinical screening tests, although target rates of completion have not yet been reached. Factors underlying these changes with time will be further explored.
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