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Quality improvement model decreased ED length of stay, readmission for children with asthma
The implementation of standardized asthma scoring and timely beta-agonist administration could reduce ED length of stay and return admissions for pediatric patients with acute asthma exacerbations, according to data published in Pediatrics.
“Asthma is one of the most common reasons children receive care in an ED, accounting for nearly 2.1 million visits in the United States in 2009,” Matthew P. Gray, MD, MS, from the department of pediatrics at Medical College of Wisconsin, and colleagues wrote. “According to the 2007 National Heart, Lung and Blood Institute Expert Panel Recommendation guidelines (EPR-3) the primary goal of ED care for asthma exacerbations is the reversal of airflow obstruction, and rapid repetitive administration of short-acting beta-agonists (SABA) has been shown to be the most effective means of accomplishing this.”
To improve the timeliness and efficacy of pediatric ED care in unity with SABA administration and asthma severity score application, Gray and colleagues used The Model for Improvement method to target knowledge, engagement, decision support and workflow enhancement at The Children’s Hospital of Wisconsin’s tertiary pediatric ED. Patients included in the improvement effort were aged between 2 years and 18 years seen in the ED between May 2012 and November 2015. All patients received at least one SABA during ED visits. The researchers implemented time series analysis for SABA administration and ED length of stay, and recorded Pediatric Asthma Severity Scores were analyzed with p-charts.
Among 5,552 patient encounters in the ED during the study period, the Pediatric Asthma Severity Score was recorded in triage more than 95% for all 3 years. SABA administration in the first year improved by 33 minutes prior to improvement testing, and low asthma severity patients improved by 17.6 minutes. Time to first SABA in high severity patients improved by 3 to 18 minutes. Time to third SABA improved by 30 minutes, low severity patients improved by 42.5 minutes and high severity patients improved 21 minutes.
In addition, ED admission rate decreased 6%, asthma-related visits between 48-hour return increased from 114 to 261 and ED length of stay for low severity patients discharge rates improved by 29.3 minutes.
“Our findings suggest that timely and efficient care may lead to reductions in both ED length of stay and admission rates,” the researchers wrote. “This is evidenced by the gains demonstrated in ED length of stay for low severity patients discharged to home, and the fact that admitted patients who received their first three SABA within 60 minutes had significantly reduced ED length of stay.” – by Kate Sherrer
Disclosure: The researchers report no relevant financial disclosures.
