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Outcome evaluation of early discharge from hospital with asthma
Sanaur R Khan1, Richard L Henry, Tara Hurst
1School of Women's and Children's Health, University of New South Wales, Randwick, New South Wales, Australia.
Insights
Discharging children with asthma from the hospital when stable on 3-hourly salbutamol is safe and can reduce hospital stays. This approach may decrease re-admissions, though further research is needed.
Area of Science:
- Pediatric Pulmonology
- Hospital Medicine
Background:
- Asthma management in children often involves frequent bronchodilator administration.
- Current discharge protocols may prolong hospital stays unnecessarily.
Purpose of the Study:
- To evaluate the safety and efficacy of discharging pediatric asthma patients on a 3-hourly salbutamol regimen versus a 4-hourly regimen.
- To assess the impact on hospital length of stay and readmission rates.
Main Methods:
- Retrospective analysis of 419 pediatric asthma admissions.
- Defined a theoretical 'time ready for discharge' (TRD) based on salbutamol frequency, oxygen use, and IV therapy.
- Compared outcomes for children discharged before and after the theoretical TRD.
Main Results:
- Discharging children on 3-hourly salbutamol appears safe, potentially shortening hospital stays by an average of 5.5 hours.
- Fewer readmissions were observed in children discharged before the theoretical TRD, though not statistically significant.
- Two children requiring oxygen and more frequent salbutamol post-theoretical TRD may have warranted readmission.
Conclusions:
- Discharging stable pediatric asthma patients on 3-hourly salbutamol is medically safe.
- This practice can significantly reduce the average length of hospital stay.
- Further investigation into specific high-risk subgroups may be beneficial.
Objective:
The aim of the study was to determine whether it was safe to discharge children with asthma from hospital when stable on 3-hourly rather than 4-hourly doses of salbutamol.
Methodology:
A retrospective study of 419 individual admissions of 359 children with asthma was undertaken. We defined a theoretical 'time ready for discharge' (TRD) for asthmatic admissions based on: (i) at least two doses of 3-hourly salbutamol and due for the third dose, (ii) no oxygen supplementation, (iii) no intravenous fluid or therapy, and (iv) time of discharge should be either before 17:30 hours or after 07:30 hours. Each admission was analysed using appropriate parameters to assess for risks and benefits of using this theoretical TRD as a guide for discharging asthmatic children from hospital.
Results:
A total of 116 (27.7%) children were discharged before our theoretical TRD, including 11 children who received salbutamol no less often than 2-hourly and 37 who had a single dose of 3-hourly salbutamol before discharge. Re-admission to hospital and representation to the Emergency Department without re-admission within 1 week of discharge were less common in the group who were discharged before they had achieved theoretical TRD than in those who were discharged at or after the theoretical TRD, although the numbers were too small to reach statistical significance. Between our theoretical TRD and actual time of discharge two children who received supplemental oxygen and more frequent salbutamol may have required re-admission.
Conclusions:
From the medical viewpoint discharge when the child is stable on 3-hourly rather than 4-hourly doses appears safe. This can be expected to shorten length of stay by an average of 5.5 h (P < 0.001).