1996 OPEN FORUM Abstracts
AN ASTHMA CARE PATH IN THE PEDIATRIC INTENSIVE CARE UNIT DECREASES HOSPITAL LENGTH OF STAY, COST, AND CHARGES
Timothy R. Mayers RRT, Robert L. Chatburn RRT, Karen McDowell MD, Carolyn Kecsmar MD. Rainbow Babies & Childrens Hospital. Cleveland, OH.
The purpose of this study was to determine the effects of an assessment-driven, algorithm-based care path (ACP) on length of stay, hospital cost, and charges to third party payers for children admitted with asthma to the pediatric intensive care unit (PICU). METHOD: During the period from 10/1/95 to 3/31/96, 27 PICU asthma admissions were studied. Entry criteria:>1 year of age, and either a history of asthma or acute symptoms of cough, wheeze or shortness of breath. Exclusion criteria: BPD, CF or congenital heart disease. Patients were assigned an asthma severity score based on their chronic disease history, chronic symptoms, and therapeutic drug usage. The patients were placed on the care path at random. The ACP is an algorithm to treat asthma patients with standardized assessments and therapy (supplemental oxygen, albuterol aerosols, corticosteriods) at prescribed intervals. The care path was initiated when the patients' acrosol frequency reached every two hours. The frequency of the assessments and/or treatments was decreased in a step-wise manner dependent on assessment of air exchange, presence of wheezing, accessory muscle usage, oxygenation and FEV1. For those patients that did not respond to this standard treatment path, an intensification protocol was administered (high-dosed albuterol mixed with ipratropium, SC epincphrine, and corticosteriods). Patients were discharged from the PICU at the discretion of the attending physician. Length of stay in the ICU was not available. Mean values for demographics and outcome variables were compared with t-tests. Race and gender were compared using a Fisher exact test. Distribution by severity class were compared with the Chi square test. Results: Demographic and outcome variables are shown below by count or mean (SD). Comparing the care path and control group, there were no differences in demographic variables or in the distributions by severity class (p>0.993).
Care Path Control p Value
Number 16 11 -
Age(years) 6.8 (4.2) 6.0 (5.4) 0.6855
Non-Caucasian 3 3 0.6675
Severe 2 5 -
Moderate 3 2 -
Mild 3 1 -
Unknown 8 3 -
Length of stay(days) 3.4 (1.0) 5.5 (2.9) 0.0144
Hospital cost/case $3,927 ($1,126) $7,670 ($2,491) 0.0909
Patient charge/case $6,737 ($6,304) $13,153 ($13,742) 0.1285
CONCLUSION: A pediatric asthma care path that is initiated in an ICU setting can result in significant decreases in hospital length of stay, while also resulting in a more cost-effective use of resources. Starting patients on a care path prior to ICU discharge saved $2,810 per patient. This also resulted in a decrease to third party payers of $5,483 per patient.