The Science Journal of the American Association for Respiratory Care
Background: Pediatric asthma hospitalizations continue to rise every year and have many variations of practice. This study evaluated the effect of implementing collaborative practice protocols to standardize care.
Methods: After reviewing the literature; a scoring system, six protocols and an intensive training program were developed. The training included-assessment, scoring, protocol, algorithm and case study application. Starting in 1996, asthmatics were placed into protocol if they were on a specific floor and had a physician's order for protocol. The control group included patients who did not have an order or were admitted to other floors. Data elements included: length of stay, the time frame between admission, bronchodilator orders and treatments. In addition, data was obtained regarding cost, patients discharged within 36 hours and the initial frequency of the bronchodilator treatments. Data was examined using analysis of variance. Results are as follows:
|Data Element||1996 (120 patients)||1997 (96 patients)|
|Average length of stay||32 hrs.||42 hrs.||34 hrs.||39 hrs.|
|Time between admit & orders||67 min.||89 min.||102 min.||98 min.|
|Time between orders & Tx||36 min.||67 min.||8 min.||57 min.|
|Time between ER & floor Tx||169 min.||218 min.||177 min.||249 min.|
|Cost of hospitalization||$2213||$2117|
|% of patients discharged within 36 hours||61%||38%|
|% of patients with initial Tx frequency of Q2 hours||32%||8%|
Experience: In 1997, there was slow acceptance of the protocol program amongst the pediatric residents as CHW is a teaching facility. Then follow up data in 1998 revealed a lack of control patients due to the popularity of the protocol; therefore we were unable to duplicate the study. The initial frequency of treatments differed as the protocol group had more Q2 hour treatments compared with the control group that was started at Q4; possibly increasing the cost. With the success of the protocol it has been expanded to include post-op cardiovascular patients and a ventilator weaning protocol.
Conclusions: By combining more aggressive care on admission and by decreasing the variances of care, the length of stay was reduced. The substantial education program for the RCP's prior to implementation ensured accurate and consistent use of the protocols.