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, 4 (1), e131

Decreasing Door-to-Door Times for Infliximab Infusions in a Children's Hospital Observation Unit


Decreasing Door-to-Door Times for Infliximab Infusions in a Children's Hospital Observation Unit

Kelly C Sandberg et al. Pediatr Qual Saf.


Introduction: Children with inflammatory bowel disease (IBD) often require infliximab infusions to manage their disease. Infusions administered in the hospital setting require the patient and their families to devote many hours away from home. Changing to a rapid infusion protocol has been shown in the literature to be safe and has the potential to decrease time spent in the hospital receiving infusions.

Methods: We describe stepwise changes made over a 4-month period to improve infliximab infusion efficiency and lessen the time spent in the hospital by IBD patients and their families. These changes included the implementation of a standardized order set, defaulting to rapid infusions for eligible patients, eliminating the post-infusion observation window, and improving the pharmacy's efficiency in preparing infusion medications. We utilized several established quality improvement tools, including a smart aim, key driver diagram, plan-do-study-act cycles, and statistical process control charts to measure these interventions.

Results: Within three months of starting, the average door-to-door time patients spent in the hospital decreased by 128 minutes (2 hours 8 minutes). This improvement amounts to 768 minutes (12 hours 48 minutes) per year of time returned for normal childhood activities outside of the hospital. There were no infusion reactions during the period monitored.

Conclusions: Implementation of a rapid infliximab infusion protocol made an impressive impact on freed family time without sacrificing patient safety. The changes we implemented could be helpful to other centers interested in decreasing in-hospital time for patients with IBD and their families.


Fig. 1.
Fig. 1.
KDD, including SMART (Specific, Measurable, Actionable, Relevant, Time-bound) aim. EMR indicates electronic medical record; KDD, key driver diagram; LOR, level of reliability.
Fig. 2.
Fig. 2.
Plan-do-study-act (PDSA) cycles. A, Sample PDSA worksheet for the transition to rapid infusion. B, PDSA Ramp: transition eligible patients/default to rapid infusions. IFX, Infliximab; GI, Gastroenterology.
Fig. 3.
Fig. 3.
Pareto charts of door-to-door time spent by families who receive infliximab infusions at the start of the project in July 2014 (A) and in October 2018 (B). DCH, Dayton Children’s Hospital; IFX, Infliximab.
Fig. 4.
Fig. 4.
Statistical process control chart with annotations. EO indicates eliminate observation; RI, rapid infusion start; SOS, standardized order set.

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