1996 OPEN FORUM Abstracts
BENCHMARK DATA FOR A PEDIATRIC ASTHMA CARE PATH IN THE EMERGENCY DEPARTMENT
Timothy R. Myers RRT, Robert L Chatburn RRT, Martha Wright MD. Rainbow Babies & Childrens Hospital. Cleveland, OH.
The purpose of this study was to benchmark the effects of an assessment-driven, algorithm-based care path (ACP) on emergency room length of stay, number of treatments, and probability of admission, in the absence of comparable historical data. METHOD: From 1/1/96-3/31/96, 332 patients were entered into the care path. 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. Respiratory distress was judged by vital signs, SpO2 and lung exam then treated with oxygen and SC epinephrine. The ACP standardized assessments and therapy (oxygen, albuterol aerosols, corticosteriods) at prescribed intervals. Patients were administered a dose of corticosteriods within the first 30 minutes if they were steroid dependent or had received > 3 bronchodilator aerosols in the previous 12 hours or > 2 in the previous 2 hours. Assessments and/or treatments were delivered every 20 minutes. Treatment was discontinued when discharge criteria were met; good air exchange, mild or absent end expiratory wheezing, no accessory muscle usage, SpO2> 93%, respiratory rate < 40/min. and peak flow > 70% predicted. Patients were observed for one hour after their last treatment then discharged. Patients not meeting discharge criteria after six aerosols or 1 hour of continuous aerosols were admitted. A severity score was assigned based on history, symptoms, and therapeutic drug usage. A Fisher Exact test was used to compare race, gender, and administration of SC epi for admit vs discharge. Chi square was used to compare severity score distributions. Unpaired t-tests were used to compare age and the outcome data. Significance was set at p = 0.05. Results: Demographic and outcome data are shown below in count, % or mean (SD).
Demographics Patients Discharged Patients Admitted p-Value
Number 198 134
Age(mean) 5.2(4.1) 4.5(3.9) 0.099
Caucasian 13 17 0.453
male 66 59 0.052
LOS (in hours) 2.0(1.0) 2.8(1.0) < 0.0001
Aerosols delivered 2.4(1.6) 5.1(1.3) < 0.0001
Assessments performed 3.9(2.0) 5.8(1.4) < 0.0001
Administered SC Epi 5 27 < 0.0001
Received < = 4 aerosols 169 29
Received >= 5 aerosols 29 105
Ten percent of admit patients went to the ICU. The probability of being admitted after receiving < = 4 aerosols was 9%; after >= 5 aerosols it increased to 31%. There was no significant difference in the distribution of severity scores between admits and discharges. CONCLUSION: The ACP seems to maintain acceptable variation in patient outcomes (mean coefficient of variation for outcome variables was 42%). Use of SC Epi and delivery >= 5 aerosols were both predictive of admission. Severity score was not predictive of admission.