As one of the largest providers of pediatric care in the state of Louisiana, with over 6000 discharges in 2009, Our Lady of the Lake Children's Hospital is focused on being a national leader in helping change the system of pediatric health care delivery.
Some of the most common reasons that parents bring children to hospitals throughout the country, include "fever," "wheezing, " and "skin infections/boils." National studies by the American Academy of Pediatrics have consistently highlighted that children routinely receive less than 50% of evidence-based recommended care. Moreover, it takes on average 17 years for a new finding that has been proved to be effective to actually impact an individual patient's care.
Here at the Children's Hospital, our clinical team has recognized that our patients should not and will not wait for effective care to be provided to all our patients. In the past two years, we have focused on improving the effectiveness of care with children who present with fever, wheezing and skin infections (boils).
The American Academy of Pediatrics report identifies 6 dimensions of health care quality:
Fever is the most common reason for child emergency room visits throughout the country, comprising 30% of all pediatric visits. When you child has a fever, the body is trying to use its immune system to fight off infections.
However, fevers are often a result of viral or bacterial infections that do not need antibiotics or lab testing. A full evaluation by an experienced pediatrician is often enough to diagnose the cause.
One of the goals of the Children's Hospital is to ensure that for children greater than six months old who are well-appearing and immunized receive effective and safe care based on recommended guidelines:
However, children under six months old usually have not completed the 1st 3 sets of immunizations and thus are at more risk for infections in the blood and urine that can be "silent" and not found on examination. Though the vast majority of these children also have viral infections that do not need antibiotics, the AAP recommends that most children younger than six months old who have a fever should have a blood and urine culture to look for a potential bacterial source.
We understand that a child with fever is often frightening to parents and families. Our team here will continue to partner with our families to ensure that we continue to improve our outcomes so that you child continues to receive high quality, effective care.
Bronchiolitis is a very common viral illness in children under age of two; it is characterized by cough, runny nose, breathing fast with a "rattling chest" and sometimes wheezing. These symptoms are caused by increased mucous production that clogs the little nasal passages and airway of children.
There are hundreds of viruses that cause this illness. Even though it is the most common reason for pediatric hospitalizations, the vast majority of children will improve on their own with no need for hospital care.
According to the AAP, effective evidence-based therapy should focus on suctioning the nose appropriately and making sure the child can feed well and avoid dehydration. The AAP does not recommend routine chest Xrays, antibiotics and steroid treatments for these children. The AAP also clearly states that routine breathing treatments (albuterol, etc) are not proven therapies for most children with bronchiolitis but should only be used in children who may have underlying "reactive airway disease" or "asthma."
Based on the recommended evidence by the AAP, your physicians at OLOL CH have adopted a system of care that avoids overuse of medications that don't work for most children with bronchiolitis and focuses on proven and effective treatments only.
If your child is admitted with symptoms that may be consistent with bronchiolitis and does not have a history of known Asthma or previous wheezing, your doctor will have an experienced respiratory therapist evaluate your child's breathing, suction out the nose, and based on an objective "scoring system," will decide whether a breathing treatment is necessary. Our goal is to reduce the overuse of mostly ineffective "breathing treatments" and steroids for these patients. Despite the evidence of what is considered effective treatment, most children's hospitals are struggling to follow the AAP recommendations and often overuse these unproven medications. For example, in a comparison group of over 30 other hospitals that care for hospitalized children with bronchiolitis in 2009, while the national average indicated that >60% of hospitalized children received one or more "breathing treatments", as seen in the below graph, OLOL CH has been successful in reducing the overuse of this often ineffective medication.
Asthma is the most common childhood chronic disease in the United States. Symptoms include fast breathing, wheezing, cough, and chest pain. Effective therapy for Asthma focuses on use of "breathing treatments" (i.e. albuterol) and steroids. There are also effective treatments to prevent Asthma "attacks," including avoid certain triggers (smoke, dust, etc) and taking prescribed medication daily if a patient meets certain criteria determined by you pediatrician. In 2009, physicians at OLOL CH consistently provided effective care for hospitalized children with 100% of all children receiving the JCAHO (a federal regulatory agency charged with ensuring that hospitals deliver safe and effective care) recommended treatment of at least one dose of a "bronchodilator" and a "steroid."
Our physicians recognize that most children with asthma do not need hospitalization and by partnering with your pediatricians, they are working hard to make sure each patient continues to receive effective treatment for asthma outside the hospital to avoid future hospitalizations.
In 2009, suspected "boils" or Abscesses was the number one reason for admission to the Children's Hospital. The most common reason for this infection is an aggressive bacteria known as Staph Aureus. Even though this bacteria is very commonly found to live on the skin and inside the nose in healthy individuals, there are times that the bacteria find its way underneath the skin and cause an infection known as an "abscess."
According to the evidence, effective therapy for abscesses should include Incision and Drainage to drain the "infection," and antibiotics used only to treat the surrounding redness. For routine abscesses, it often takes less than 24 hours after effective incision/drainage therapy when your child will improve to be discharged home. Our focus is on the effective use of timely incision/drainage and not overusing powerful antibiotics that sometimes do more harm and good.
As you can see below, Our Lady of the Lake Children's Hospital has improved significantly in the deliver of effective care for these patients, with >70% of our patients now receiving the recommended incision/drainage (which is approximately 100% of patients who qualify) and <10% receive IV administered antibiotic Vancomycin. Because of this system of effective and evidence based care, our patients routinely spend less than 48 hours in the hospital with very rare readmissions.