P0129 - Improving Adherence to Recommendations for Follow-up Echocardiogram Timing in Children with Kawasaki Disease

Background: In 2017 the American Heart Association (AHA) published evidence-based guidelines for the diagnosis, treatment, and long-term management of Kawasaki Disease (KD). To determine adherence to these guidelines, we analyzed baseline data from KD patients admitted to our institution from January through December 2018 (15 patients) and used a Pareto chart to determine the greatest deviation, which was timing of follow-up echocardiograms. According to the AHA, echocardiograms should routinely be obtained within 1 to 2 weeks and 4 to 6 weeks after treatment for uncomplicated cases (defined as no ectasia on diagnostic echocardiogram). Our baseline data showed none of the patients received their initial follow-up echocardiogram within the 1 to 2 week time frame recommended in the AHA guidelines (median 5.25 weeks). The aim of this study was to improve the median initial outpatient pediatric cardiology follow-up time for patients hospitalized with uncomplicated Kawasaki Disease from 5.25 weeks to 2 weeks after IVIG treatment by May 2020.
Methodology: The Plan-Do-Study-Act (PDSA) method of quality improvement was used for this project. Baseline assessment included review of patient medical records for 1 year prior to the initial intervention. Data collected included the treatment received during hospitalization, results and timing of echocardiograms, and the time interval between initial treatment and subsequent echocardiograms.
Interventions: The intervention in the first PDSA cycle was a meeting between a pediatric hospitalist and multiple pediatric cardiologists to discuss applying the AHA 2017 guidelines to patients at our institution. The intervention in the second PDSA cycle included implementing a KD follow-up protocol to be used by inpatient providers (pediatric residents and hospitalists) and educating pediatric residents via email and an in-person teaching session on this protocol.

Discussion: After the initial intervention, there was statistically significant improvement in the timing of initial outpatient pediatric cardiology follow-up, which shifted the median time from 5.25 weeks post-IVIG treatment to 2 weeks post-IVIG treatment. After the first PDSA cycle, 50% of patients received initial follow-up echocardiogram within the AHA guidelines. In the second PDSA cycle, the median follow-up time of 2 weeks was sustained, and 100% of patients received initial follow-up echocardiogram within the AHA guidelines. Show rate to follow-up appointments was used as a balancing measure, and it did not significantly change.

Conclusion: Using quality improvement methodology, two easily replicated interventions improved the median outpatient follow-up time for repeat echocardiogram to align with AHA guideline recommendations.