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Improving efficiency of pediatric emergency asthma treatment by using metered dose inhaler.
- Source :
-
Journal of Asthma . Oct2019, Vol. 56 Issue 10, p1079-1086. 8p. 1 Chart, 3 Graphs. - Publication Year :
- 2019
-
Abstract
- Objective: Evidence suggests using metered dose inhaler (MDI) to treat acute asthma in the Emergency Department reduces length of stay, though methods of implementation are lacking. We modified a treatment pathway to recommend use of MDI for mild-moderate asthma in a pediatric ED. Methods: A baseline review assessed discharged patients >2 years with an asthma diagnosis and non-emergent Emergency Severity Index triage assessment (3/4). Our multi-disciplinary team developed an intervention to increase MDI use instead of continuous albuterol (CA) using the following: (1) Redesign the asthma pathway and order set recommending MDI for ESI 3/4 patients. (2) Adding a conditional order for Respiratory Therapists to reassess and repeat MDI until patient reached mild assessment. The primary outcome was the percentage discharged within 3 hours, with a goal of a 10% increase compared to pre-intervention. Balancing measures included admission and revisit rates. Results: 7635 patients met eligibility before pathway change; 12,673 were seen in the subsequent 18 months. For target patients, the percentage discharged in <3 hours increased from 39% to 49%; reduction in median length of stay was 33 minutes. We identified special cause variation for reduction in CA use from 43% to 25%; Revisit rate and length of stay for higher-acuity patients did not change; overall asthma admissions decreased by 8%. Changes were sustained for 18 months. Conclusion: A change to an ED asthma pathway recommending MDI for mild-moderate asthma led to a rapid and sustained decrease in continuous albuterol use, length of stay, and admission rate. [ABSTRACT FROM AUTHOR]
Details
- Language :
- English
- ISSN :
- 02770903
- Volume :
- 56
- Issue :
- 10
- Database :
- Academic Search Index
- Journal :
- Journal of Asthma
- Publication Type :
- Academic Journal
- Accession number :
- 138431699
- Full Text :
- https://doi.org/10.1080/02770903.2018.1514629