2000 OPEN FORUM Abstracts
A Pediatric Asthma Fast Track (PAFT) Can Reduce The Number of Patients Admitted to An Acute Care Unit
Thomas J. Kallstrom, RRT, FAARC, Cleveland
Background: Asthma admissions to our acute care 460 bed community/teaching hospital have been perceived to be a problem. One of targets for 1999 was a 20% or less admission rate to the hospital from the emergency department. Method: We addressed this problem in an interdisciplinary manner. We organized a task force which included nurses, respiratory therapists (RT), physicians, risk management and hospital administrators. Our goal was to develop a process by which we could assess and treat expeditiously and to reduce the number of admissions. Our PAFT was developed using the EPR-2 Guidelines for the Diagnosis and Management of Asthma, released by the NIH in 1997. Management of the disease was directed by the use of a protocols (algorithms), an already familiar tool already used on our inpatient asthma care pathway. Patients entering the PAFT had to be over the age of one, already diagnosed with asthma, and under the care of a hospital affiliated physician. When the patient arrived at the hospital they went immediately to the pediatric ward, where the PAFT area was located. This area has continual RN/RT coverage. Key to the PAFT protocol is assessment, therapeutic intervention, and patient directed education. Patients also had access to an interactive asthma education program that was computer based. Patients initially received Q 20 minute assessment and appropriate therapy. The intervals between interventions were extended if the patient responded. If a patient did not significantly improve within 4 hours they were admitted to the acute care ward and then placed in the pediatric asthma pathway. Results: In a seven month period, 41 patients were cared for in the PAFT. Of these, 29 patients were discharged within 3 hours (71%). The average number of aerosols was 3.5/patient. Twelve were placed in observation status (29%) and averaged 6 aerosol treatments. Only 11% of the patients seen in the PAFT were admitted to the acute care ward. For all patients, the first assessment and subsequent aerosol treatment was given by 11 minutes (from admission to treatment). Conclusions: Using a PAFT, patients can be rapidly assessed and appropriately cared for. This can be accomplished with a joint effort between RT, nurses, physicians, and hospital administration. We have developed a post discharge survey which will be used to track outcome indicators.