The Science Journal of the American Association for Respiratory Care

2009 OPEN FORUM Abstracts

INTEGRATED ASTHMA CARE DELIVERY SYSTEM: A NEW MINDSET IN PRACTICE ACROSS CARE SETTINGS

Donna L. Petersen1, Peter Kilbridge2; 1Respiratory Care, St Louis Children’s Hospital, St Louis, MO; 2Medical Director Information Technology and Clinical Effectiveness, St. Louis Children’s Hospital, St Louis, MO

Background: The Department of Respiratory Care at St. Louis Children’s Hospital(SLCH) noted an increase in the number of asthmatic patients requiring urgent administration of bronchodilator therapy. A Quality Initiative project began investigating the increased need for Now/Stat calls. Closer examination revealed significant delays in treatment during the admission process from the Emergency Department(ED), resulting in patient deterioration. Since 2001, more than 50% of the asthma patients admitted from the ED had times between treatments in excess of 3 hours, when standard of care dictates a maximum period of 2 hours for these patients. The deterioration in care during the transfer process appeared to be related to the removal of respiratory therapist from the ED in 1999 due to resource limitations. Current care is based on broadly accepted NHLBI guidelines available for outpatient, ED, and inpatient asthma management, but there is substantial room for improvement during patient transitions between these care settings. Method: In 2007 there were 2300 ED visits and 885 admissions for Diagnosis of Asthma, the number one admitting diagnosis at SLCH. A task force, compromised of a multidisciplinary committee was charged by hospital leadership to examine the extent and nature of the problem and develop recommendations for improvement. Three subgroups were formed: ED to inpatient floor, floor to ICU/ICU to floor, and discharge process group. The charge for each group were to map out processes, identify opportunities, and recommend an implementation plan. Final recommendations made by the task force were implemented in June 2008 with the exception of an assigned RT to the ED which is anticipated in Summer 2009. Results: Average times between last ED treatment and first inpatient treatment decreased from 163 minutes to 127 minutes (p<0.01). Proportion of patients waiting more than 140 minutes between treatments decreased from 65% to 27%. (Image 1) Conclusion: Keys to success include working with the ED nursing and medical staff to reinforce the concept that they are but one component of an integrated care delivery system, not an independent clinic. Common goals (particularly that the asthma patients should receive timely treatments regardless of location), common measures across settings, and common accountability permitted the task force to work as a team introducing significant changes in mindset as well as practice across settings. Sponsored Research - None

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