Optimizing Value and Reducing Medication Costs in the Pediatric Intensive Care Unit

In an effort to transform workflows through digital health innovations, Akron Children’s Hospital knew identifying areas that could provide the most impact through information and technology was key.

One such area of focus was the hospital’s pediatric intensive care unit (PICU). When the hospital recognized that up to 35 percent of the variable costs accumulated during pediatric intensive care unit (PICU) visits were related to tests, medication costs or procedures, the hospital wanted to ensure these were contributing to quality care.

For example, one high-cost medication given frequently in the pediatric intensive care unit (PICU) is ipratropium bromide hydrofluoroalkane (IB HFA), a medication used to treat pediatric asthma. This medication was identified as the fifth most expensive medication administered in the PICU. After findings showed these medications were not enhancing quality care, the hospital considered the pertinent need to optimize PICU value for the benefit of both patients and providers. To do so, Akron Children’s Hospital embarked on an initiative to reduce usage of IB HFA medication to reduce unnecessary medication costs, without negatively impacting outcomes such as a patient’s length of stay.

Reducing Unnecessary Medication Costs

Akron Children’s Health convened a multidisciplinary team to launch an initiative aimed at optimizing PICU care. The team included providers, nurses, clinical pharmacists, respiratory therapists and enterprise asthma pathway staff. Diverse in their areas of expertise, the team worked diligently to drive these improvements.

A goal was established to reduce the medication’s utilization by 30 percent in asthma patients in the PICU, without negatively impacting the quality of care (as measured by asthma patient length of stay). Improvement interventions were staged using the Plan-Do-Study-Act methodology. This included evidence-based asthma pathway modification, order set optimization, pharmacy process changes and staff education. In addition, the team leveraged quality improvement methodology (key driver diagrams, tests of change, process/outcome/balancing measures) to implement a systematic improvement strategy. Additional measurements included cost adjusted for asthma patient admissions and a balancing measure of asthma patient length of stay.

In 2016, the organization’s IB HFA medication costs added up to more than $72,000 – or 287 canisters of the medication dispensed. Following implementation, this reduced to 51 canisters dispensed – demonstrating an 82 percent reduction in IB HFA utilization. As a result, Akron Children’s Hospital was able to achieve cost savings of $55,724 following these efforts, while observing zero increase in PICU asthma patient length of stay. The organization continues to make progress on these efforts.

"A survey team visits the hospital to ensure our electronic medical record technology is being used in a multidisciplinary way to achieve maximum value for our staff and patients," said Harun Rashid, chief information officer at Akron Children’s Hospital. "We are in an elite group of users who have a complete end-to-end story of a patient's journey through our health system – allowing for a comprehensive view of the patient's record leading to more efficient and cost-effective care."

Electronic Medical Record Adoption Model Stage 7 Validation

HIMSS is pleased to recognize Akron Children’s Hospital for their HIMSS Electronic Medical Record Adoption Model (EMRAM) Stage 7 validation.

“Grace Wakulchik, president and CEO of Akron Children’s Hospital, wanted more than an ‘expensive pencil’ from her EMR investment,” said Philip Bradley, regional director, North America, HIMSS Analytics. “Using their LEAN program and the HIMSS Analytics EMRAM standards, Akron Children’s has created what Harun Rashid, CIO describes as a ‘smart EMR.’”

"This is a milestone achievement for Akron Children's Hospital," said Grace Wakulchik, president and CEO of Akron Children’s Hospital. "It represents our commitment as an organization, and the dedication of our Information Services Division and our caregivers, to ensuring that we have the best technology available to deliver the highest quality care at the bedside. Our investment in the HIMSS Analytics EMRAM is an investment in the health and wellbeing of the families we serve, and it is integral to our vision for the future."

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Updated February 21, 2020