Improving care through standardized treatment of spontaneous pneumothorax

Abstract How this paper will improve care: This quality improvement project in a tertiary children's hospital demonstrates that standardization of care of primary spontaneous pneumothoraces, guided by radiological parameters in conjunction with the number of previous episodes, reduces hospital length of stay and diagnostic radiation exposure. Purpose The objective of this quality improvement (QI) initiative was to implement a standardized clinical treatment protocol for patients presenting with primary spontaneous pneumothorax (PSP) in order to decrease hospital length of stay (LOS), diagnostic radiation exposure, and related cost. Methods Baseline data from patients admitted with PSP from January 1, 2016 to July 31, 2018 were compared to data from patients managed using a newly developed evidence-based treatment pathway from August 1, 2018 to December 31, 2019. Standard QI methodology was used to track results. Results Fifty-six episodes of PSP were observed during the baseline period and 40 episodes of PSP following initiation of the PSP protocol. The average LOS decreased from 4.5 days to 2.9 days. Patients underwent an average of 8.8 X-rays per admission pre-intervention versus 5.9 post-intervention. The rate of CT scans decreased from 45% to 15% (p = 0.002). There was no significant difference in the rates of 30-day recurrence between the pre-intervention (13%) and post-intervention (10%) groups (p = 0.7). Average admission costs per patient decreased by $1322 after adoption of the pathway. Conclusions Adoption of a standardized treatment protocol for PSP led to a reduction in LOS, diagnostic imaging utilization, and cost without increasing clinical recurrence. Type of Study. Quality Improvement. Level of Evidence. Level III.