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Editorial
. 2023 Sep;68(9):1195-1201.
doi: 10.4187/respcare.10930. Epub 2023 May 16.

Implementation of a Respiratory Therapist-Driven Protocol for Spirometry and Asthma Education in a Pediatric Out-Patient Primary Care Setting

Haley M Long  1 , Kim A Cobb  1 , Pam A Leisenring  1 , Sandy E King  1 , L Denise Willis  1 , Robert D Pesek  2 , Ariel Berlinski  3
Affiliations
Editorial

Implementation of a Respiratory Therapist-Driven Protocol for Spirometry and Asthma Education in a Pediatric Out-Patient Primary Care Setting

Haley M Long et al. Respir Care. 2023 Sep.

Abstract

Background: Best practice guidelines for asthma management recommend education and spirometry at specific intervals. A written asthma action plan with education and spirometry is ordered at the discretion of physicians at our institution. An initial chart review revealed that asthma education and spirometry were not consistently ordered in the pediatric primary care clinics. This quality improvement study aimed to increase frequency of spirometry and asthma education in children with asthma seen in pediatric primary care through use of a respiratory therapist (RT)-driven protocol.

Methods: The protocol established that spirometry and education would be done annually for children ≥ 6 y of age with intermittent asthma and every 6 months for persistent asthma. RTs identified eligible subjects and placed the electronic medical record orders before the clinic visit. Physicians were invited to complete a questionnaire before and after protocol implementation to assess barriers and protocol satisfaction.

Results: Nine hundred and thirty-two children were included. Prior to protocol implementation, spirometry and education were completed in 64.9% and 62.6% of eligible children, respectively. Following protocol implementation, spirometry and education were significantly increased to 92.7% (P < .001) and 88.5% (P < .001), respectively. Physicians identified interruption in clinic flow as the primary barrier for ordering spirometry and were satisfied with the protocol. Physicians stated that communication with RT improved through use of this protocol.

Conclusions: Implementation of an RT-driven protocol in an out-patient pediatric primary care setting significantly increased utilization of spirometry and education for children with asthma. RTs working in the pediatric out-patient primary care setting played a vital role in achieving best practices for asthma management. The implementation of the protocol enhanced interdisciplinary communication.

Keywords: asthma; asthma action plan; children; out-patient; primary care; protocol; quality improvement; respiratory therapist; spirometry.

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Conflict of interest statement

Ms Willis is a section editor for Respiratory Care. Dr Berlinski discloses relationships with Cystic Fibrosis Foundation, Mylan, National Institute of Health, Therapeutic Development Network, Trudell Medical International, Vertex, UpToDate, Hollo Medical Inc, and the International Pharmaceutical Aerosol Consortium on Regulation and Science. The remaining authors have disclosed no conflicts of interest.

Figures

Fig. 1.
Fig. 1.
Out-patient respiratory therapist–driven protocol. RT = respiratory therapist.
Fig. 2.
Fig. 2.
Flow chart.
Fig. 3.
Fig. 3.
Change in frequency of spirometry and asthma education completed before and after protocol implementation. Gray line shows goal (80% completion).
Fig. 4.
Fig. 4.
P-chart for completion of spirometry (A) and asthma education (B) before and after protocol implementation. Upper control limit (UCL) and lower control limit (LCL) show ± 3 SD. Gray horizontal lines denote the control limit (mean of all values). Vertical dotted lines represent initiation of the protocol (October 2021). The change in color occurs each time the line crosses the control limit line.
See this image and copyright information in PMC

References

    1. Asher MI, Rutter CE, Bissell K, Chiang CY, El Sony A, Ellwood E, et al. ; Global Asthma Network Phase I Study Group. Worldwide trends in the burden of asthma symptoms in school-aged children: Global Asthma Network phase I cross-sectional study. Lancet 2021;398(10311):1569–1580. - PMC - PubMed
    1. National Asthma Education and Prevention Program. Expert Panel Report 3 (EPR-3): guidelines for the diagnosis and management of asthma-summary report 2007. J Allergy Clin Immunol 2007;120(5 Suppl):S94–138. - PubMed
    1. Global Initiative for Asthma (GINA). GINA Report, global strategy for asthma management and prevention. Updated 2022. Available at: https://ginasthma.org/gina-reports. Accessed December 12, 2022.
    1. Miller AG, Breslin ME, Pineda LC, Fox JW. An asthma protocol improved adherence to evidence-based guidelines for pediatric subjects with status asthmaticus in the emergency department. Respir Care 2015;60(12):1759–1764. - PubMed
    1. McFadden ER, Jr., Elsanadi N, Dixon L, Takacs M, Deal EC, Boyd KK, et al. . Protocol therapy for acute asthma: therapeutic benefits and cost savings. Am J Med 1995;99(6):651–661. - PubMed

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