ISQUA17-2582THE RELATIONSHIP BETWEEN QUALITY IMPROVEMENT AND RESILIENT HEALTHCARE; NUANCES, COMPLEXITIES AND TRADE-OFFS

Objectives: Kawasaki Disease (KD) is a acute febrile systemic vasculitis and mainly affected children less than 5 years old. It has been the major cause of acquired heart disease in children from developing countries. The most important complication of KD is coronary artery involved that will cause activity limitation in the whole life. It will also bring anxiety and stress to family who had KD patient. In this stud, we used precision medicine plan to diminish medical cost, to shorten diagnosis duration, and to improved clinical care satisfaction. Methods: The average diagnosis days in year 2015 was 7.4 days after disease onset and with 78.6 % response to initial intravenous immunoglobulin (IVIG) treatment in the Kawasaki Disease Center of Kaohsiung Chang Gung Memorial Hospital in Taiwan. Anxiety scale (ranged from 0-100mm, Wewers & Lowe,1990) showed status of extremity anxiety with average scale of 79.1mm in family. The satisfactory scale including physician care, nursing, team care and education tool survey showed only 68.7%. We found the major problems were from searching admission ward for KD patient, waiting for physician check and for making diagnosis of KD. Process cycle efficiency (PCE) was 5.8%. Our precision medicine care were included KD specific admission ward with specific nursing and physician care, team care to diminish the diagnosis duration, interesting and useful education tools and set up the clinical treatment protocol. The clinical characteristics of KD include fever lasting for more than 5 days, as well as at least 4 of the following 5 symptoms: diffuse mucosal inflammation with strawberry tongue and fissure lips (1 mouth), bilateral non-purulent conjunctivitis (2 eyes), unilateral cervical lymphadenopathy (3 fingers check lymph node), indurative angioedema over the hands and feet (4 limbs), dysmorphic skin rashes (5 much skin rashes). The 5 KD character symptoms may be not easy to remember or keep in mind for parents or first line clinician. Easier way to remember the 5 characters of KD is important for parents and clinician to identify KD earlier. In order to help remember the 5 KD character symptoms, we created the “Kuo mnemonic” for rapid memory of KD diagnosis criteria that is modified from our previous review. Results: After the precision medicin care, in year 2016, we found the diagnosis days was shorten from 7.4 to 5.8 days after disease onset. IVIG treatment response showed significant increase from 78.6% to 90%. The anxiety scale of family were significant improved from 78.3mm at diagnosis to 30.1mm after treatment (p<0.0001, paired t test). The satisfaction scale improved from 68.7% to 95.1%. PCE also showed markedly improved from 5.8% to 6.9% (19% improvement). We have set up the KD clinic for outpatient check and specific ward for KD patients. The figure showed our KD team. Conclusion: In this study, we reported that precision medicine care with education tool, team care and treatment standard protocol setup can improved treatment outcome and anxiety condition of family. It will also improve medical cost through diminish IVIG treatment failure rate and coronary artery involved. References Kuo HC, Yang KD, Chang WC et al. Kawasaki disease: an update on diagnosis and treatment. Pediatr Neonatol 2012;53:4–11. Kuo HC, Hsu YW, Wu MS et al. Intravenous immunoglobulin, pharmacogenomics, and Kawasaki disease. J Microbiol Immunol Infect 2016;49:1–7.