Streamlining Kawasaki disease care: a quality improvement initiative to safely reduce length of stay.

Objectives: Kawasaki Disease is the most common cause of paediatric acquired heart disease and one of the most resource-intensive acute paediatric conditions to treat. Hospitalization for Kawasaki Disease is a stressful event for children and caregivers, leading to increased use of emergency resources after resolution of disease. A quality improvement clinical pathway was introduced to alleviate strain on inpatient resources and reduce length of stay by 33% over 12 months. Methods: All patients diagnosed and treated for Kawasaki Disease at this institution were included. The primary outcome measure was length of stay. Patients with complicated Kawasaki Disease (i.e., Admission to intensive care) were excluded from outcome measurement, however process and balancing measures were collected for all patients. Balancing measures included rate of urgent care access post-discharge and patient satisfaction. Results: Forty-nine patients were included in the study, with length of stay data collected for 19. The average length of stay was 46 hours (17% reduction from a pre-intervention baseline of 55 hours). Process measures showed >75% uptake in change ideas following two plan, do, study, act (PDSA) cycles. Patient satisfaction was high with no safety concerns after discharge. Approximately $25,402 was saved over 49 admissions through reductions in length of stay and laboratory investigations. Conclusion: While the primary objective was not met, a sustained 17% reduction in length of stay was achieved without compromising patient safety or satisfaction. This initiative successfully implemented a standardized clinical pathway through strong collaborator engagement and patient-driven change ideas.