The Science Journal of the American Association for Respiratory Care

2009 OPEN FORUM Abstracts

DECREASING THE LENGTH OF STAY IN THE EMERGENCY DEPARTMENT FOR PATIENTS DISCHARGED WITH ASTHMA

Mary K. Hart, Vannie Alexander, James D’Etienne, Mark Millard; Baylor University Medical Center, Dallas, TX

Background On an average, 80 adult asthma patients are treated in the Emergency Department (ED) at Baylor University Medical Center each month. The average length of stay (LOS) is 278 minutes for those discharged and 516 minutes for those admitted. Asthma can be controlled with proper treatment and ED management should take no longer than 180 minutes based on Expert Panel Report 3. The opportunity for improvement was evident. Methods A quality improvement multidisciplinary Asthma ED Team was formed to determine what was causing the significant LOS. The team leader coordinated and facilitated meetings with MDs, RTs, and RNs. Quality improvement tools, such as a fishbone cause and effect diagram, run charts, and affinity charts, were used to help identify and prioritize problems identified by the team. During the first brainstorming session the team discovered that no standardized asthma protocol existed for ED staff to follow. An asthma protocol was developed and FEV1 meters were given to all RTs to use to determine severity and treatment effectiveness. A breath actuated nebulizer (BAN) was introduced to deliver all bronchodilator therapy more effectively and safely. Staff was educated on the asthma guidelines, choice of medications, how to use the protocol, document, and communicate effective patient handoff. The team leader spent time working with staff in the ED to help improve their performance as they gained more confidence. Physician champions met one on one with physicians to discuss specific cases. Ongoing chart reviews helped identify areas that needed further improvement. Results Having an asthma protocol streamlined the management of asthma in the ED. It has taken time to see the improvements purely because of “changing the culture”. Having the RTs “Drive the Protocol” has made a big difference. This has given them the opportunity to prove themselves as invaluable members to the team. After implementing the asthma protocol 4 months ago, the average LOS has decreased by 51 minutes and FEV1 measurements are performed 99% of the time. Medication delivery using the BAN is effective allowing some patients to be discharged who would normally be admitted. Conclusion The ED Asthma Protocol Team has made a positive impact in how asthma care is delivered in the ED. They will continue to work towards their goal as they improve their team dynamics. The next steps for this team are to tackle discharge planning, physician referrals and follow-up care. Sponsored Research - None

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