2002 OPEN FORUM Abstracts
ASSESSMENT OF CURRENT PEDIATRIC ASTHMA INITIATIVES AND FUTURE NEEDS IN HOSPITALS ACROSS THE UNITED STATES
Timothy R. Myers BS, RRT and Thomas J. Kallstrom, RRT, FAARC for the American Respiratory Care Foundation, American Association for Respiratory Care & the Environmental Protection Agencies Indoor Division. Dallas, TX & Washington D.C.
Introduction. There are various approaches to asthma care and education of pediatric patients once they arrive at an acute care facility. Our particular interest was how respiratory therapists in pediatric hospitals (traditional) and adult/pediatric (non-traditional) hospitals manage asthma-related care and education to children. Our primary objective was to benchmark and compare current initiatives and educational in both traditional and non-traditional pediatric asthma settings.
Methods. We designed a needs assessment instrument that sought information about how respiratory care departments practiced inpatient asthma care and to identify and categorize asthma education initiatives. For centers that identified performing education initiatives, we also queried them on implementation of indoor environmental trigger education. This tool was distributed to 500 hospitals offering pediatric emergency or inpatient services.
Results. 133 hospitals (26.6%) responded to the survey. An additional 27 (5%) were eliminated, as they responded to providing neither pediatric inpatient nor emergency services. The majority of responding centers (65%) were located in urban areas, reported to be non-traditional pediatric hospitals (41.7%), and considered themselves academic/teaching facilities (62.5%). Specific hospital areas that reported treatment and / or education initiatives for pediatric asthma patients were as follows: ED =90.7%, inpatient =83.7%, and outpatient =60.5%. On average, less than 50% of the responding hospitals were currently using protocolized care. Approximately 1/3 of the respondents were developing hospital-based protocols and 24.6% were developing ED based protocols. Across the board for all hospitals, the RT was responsible for asthma education (99.2%), followed by the RN (69.5%), physician (51.9%), and pharmacist (17.6%). In adult/pediatric hospitals, 52%of respondents spend < 1-hour on patient education, while in pediatric hospitals, 71% of the respondents spend between 1-5 hours. The table below lists respondent percentages for key initiatives, and the comparative p-values determined by Chi Square Analysis.
|Use of ED Protocol||45.4%||41%||60%||0.01|
|Use of Inpatient Protocol||49.6%||42%||74.2%||<0.001|
|Staff is Trained||22.5%||19.4%||32.3%||0.05|
|Staff Asthma Competency Tested||30%||18.9%||15.5%||0.71|
|Interested in Toolkit||84.7%||86%||80.6%||0.45|
Conclusions: A significant difference exists between traditional and non-traditional hospitals in treating pediatric asthma with protocol therapy. While the majority of responding hospitals provided asthma trigger education, respiratory care staff training and competency occurred less than a third of the time. Based on the results of this study, further work on the development of asthma protocol therapy, staff training and competency testing needs to be done.