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Original Research ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Pediatr. | doi: 10.3389/fped.2019.00112

Quality Improvement Initiative to Reduce Admissions for Nephrotic Syndrome Relapse in Pediatric Patients

  • 1Johns Hopkins University, United States
  • 2Children’s National Health System, United States
  • 3Pediatric Nephrology, School of Medicine and Health Sciences, George Washington University, United States

Introduction: Childhood nephrotic syndrome is frequently seen in pediatric nephrology practice and often requires patient hospitalization for management. Numerous complications of this disease can be managed in an outpatient setting if brought to the attention of the medical team in a timely manner. Outpatient management will reduce healthcare cost and improve patient safety. The goal of this quality improvement initiative was to reduce admissions for nephrotic syndrome relapse from 8 to less than 5 admissions at a single center in a 3-month period.
Methods: Fish-bone analysis was used to determine barriers to early recognition of relapse and successful outpatient care. Patient education about the disease process was identified as the primary barrier. A standardized approach to patient education as well as educational materials were developed. Champions were identified within each stakeholder group to train and disseminate the new process. Admission counts were compared from 3 years prior to implementation to 2 years post-implementation. Clinic visits for nephrotic syndrome were tallied as a balancing measure. Patients were surveyed in the outpatient clinics about whether they had ever received the education as a process measure.
Results: Admission counts were reduced and met goal for the first 3 quarters that were examined; however, the number of admissions went above target in the last quarter. Clinic visit numbers did not change over the study period. Process measure showed that 75-80% of families were provided with nephrotic syndrome education.
Conclusion: A standardized approach to patient and family education about idiopathic nephrotic syndrome can reduce admissions for management of relapse. This will reduce healthcare expenditure as well as improve patient safety.

Keywords: pediatric, Nephrotic Syndrome, Education, Quality Improvement, Admission

Received: 04 Jan 2019; Accepted: 08 Mar 2019.

Edited by:

Agnieszka Swiatecka-Urban, University of Pittsburgh, United States

Reviewed by:

Tennille N. Webb, University of Alabama at Birmingham, United States
Rasheed Gbadegesin, Duke University, United States  

Copyright: © 2019 Charnaya and Ahn. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Dr. Olga Charnaya, Johns Hopkins University, Baltimore, United States,