The Science Journal of the American Association for Respiratory Care

2000 OPEN FORUM Abstracts

A Pediatric Asthma Care Path (PACP) Can Reduce Length of Stay (LOS)

Thomas J. Kallstrom, RRT, FAARC, Cleveland

Background: Recent statistics released by the National Institutes of Health (NIH) note the prevalence of pediatric asthma has increased by 160% over the last 15 years. Incidence of pediatric asthmatic in our community is high as it is throughout the country. Our risk management department had noted an increased number of asthma admissions, readmissions, and long length of stay at our facility over the past several years. There was also considerable consternation between the respiratory therapy (RT) and nursing staff regarding RT availability to provide aerosolized bronchodilator therapy in a timely and consistent fashion. A Team consisting of RT, nurses, physicians, social workers and pharmacists were charged with the task of developing a protocol that could address our increased number of admissions and length of stays (LOS) Method: Our PACP 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 the use of protocols (algorithms). This pathway was a joint effort with nursing and RT doing all of the assessment and treatments. Patients were scored with objective data that allowed them to provide, withhold, or to intensify therapy. The PACP was designed to decrease repetitive and unnecessary therapies and to provide patients with essential education. This we hoped would enable them to better recognize signs and symptoms of deterioration and eventual treatment in hopes of preventing a trip to the emergency department. A variation of this same Asthma Care Path was developed at Rainbow Babies and Children's Hospital in Cleveland several years previous.

In January of 1999, nursing and RT launched a new pathway for pediatric asthma patients. The criteria was limited to those over the age of one year and who had already been diagnosed with asthma. The average LOS for pediatric asthma patients one year prior to implementation of the pathway was 2.26 days/patient. One year into our program we have seen the average LOS drop to 1.54 days/patient. This is a 35% decrease. Conclusion: LOS can be positively influenced by a PACP. Reduction in LOS is only part of what should be measured. Because of the need to measure after discharge we have developed an outcomes measurement tool built into a call-back survey. We hope to report on this in a future abstract.

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