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. 2015 Oct;52(8):806-14.
doi: 10.3109/02770903.2015.1019086. Epub 2015 May 19.

Clinical pathway improves pediatrics asthma management in the emergency department and reduces admissions

Arpi Bekmezian  1 , Christopher Fee, Ellen Weber
Affiliations

Clinical pathway improves pediatrics asthma management in the emergency department and reduces admissions

Arpi Bekmezian et al. J Asthma. 2015 Oct.

Abstract

Objective: Poor adherence to the National Institute of Health (NIH) Asthma Guidelines may result in unnecessary admissions for children presenting to the emergency department (ED) with exacerbations. We determine the effect of implementing an evidence-based ED clinical pathway on corticosteroid and bronchodilator administration and imaging utilization, and the subsequent effect on hospital admissions in a US ED.

Methods: A prospective, interventional study of pediatric (≤21 years) visits to an academic ED between 2011 and 2013 with moderate-severe asthma exacerbations has been conducted. A multidisciplinary team designed a one-page clinical pathway based on the NIH Guidelines. Nurses, respiratory therapists and physicians attended educational sessions prior to the pathway implementation. By adjusting for demographics, acuity and ED volume, we compared timing and appropriateness of corticosteroid and bronchodilator administration, and chest radiograph (CXR) utilization with historical controls from 2006 to 2011. Subsequent hospital admission rates were also compared.

Results: A total of 379 post-intervention visits were compared with 870 controls. Corticosteroids were more likely to be administered during post-intervention visits (96% vs. 78%, adjusted OR 6.35; 95% CI 3.17-12.73). Post-intervention, median time to corticosteroid administration was 45 min faster (RR 0.74; 95% CI 0.67-0.81) and more patients received corticosteroids within 1 h of arrival (45% vs. 18%, OR 3.5; 95% CI 2.50-4.90). More patients received > 1 bronchodilator dose within 1 h (36% vs. 24%, OR 1.65; 95% CI 1.23-2.21) and fewer received CXRs (27% vs. 42%, OR 0.7; 95% CI 0.52-0.94). There were fewer admissions post-intervention (13% vs. 21%, OR 0.53; 95% CI 0.37-0.76).

Conclusion: A clinical pathway is associated with improved adherence to NIH Guidelines and, subsequently, fewer hospital admissions for pediatric ED patients with asthma exacerbations.

Keywords: Clinical guidelines; NIH Guidelines; corticosteroid; crowding; emergency medicine; exacerbation; imaging utilization; quality of care.

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Figures

Figure 1
Figure 1
Flow diagram for total patients included in the study.
Figure 2
Figure 2
Proportion receiving corticosteroids within one hour of ED arrival.
See this image and copyright information in PMC

References

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