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Effect of an integrated care pathway on acute asthma/wheeze in children attending hospital: cluster randomized trial

Steve Cunningham1, Claire Logan, Linda Lockerbie

  • 1Department of Respiratory and Sleep Medicine, Royal Hospital for Sick Children, Edinburgh, United Kingdom.

The Journal of Pediatrics
|February 19, 2008
PubMed

Insights

An integrated care pathway (ICP) for acute pediatric asthma improved patient education and reduced prescribing errors. While it did not affect recovery time, the ICP showed potential for reducing hospital length of stay.

Area of Science:

  • Pediatric Emergency Medicine
  • Healthcare Management
  • Clinical Pathways

Background:

  • Acute asthma and wheeze are common reasons for pediatric emergency department (ED) visits.
  • Standard care pathways may not always optimize treatment or patient education for acute pediatric asthma.

Purpose of the Study:

  • To evaluate the effectiveness of an integrated care pathway (ICP) in improving the care of children with acute asthma/wheeze presenting to the ED.
  • To assess the impact of the ICP on patient outcomes, treatment adherence, and healthcare resource utilization.

Main Methods:

  • A cluster randomized design was used, involving 298 children (ages 2-16) with acute asthma/wheeze.
  • Participants were randomized to either standard care or care managed by an ICP.
  • Outcomes measured included medication use, patient education, length of stay, prescribing errors, and follow-up care.

Main Results:

  • Children receiving ICP care were more likely to receive prednisolone and advice for primary care review.
  • The ICP led to a significant reduction in prescribing errors (30%) and improved adherence to discharge planning.
  • No significant difference was observed in the rate of recovery, although the ICP modestly reduced length of stay when discharge criteria were met.

Conclusions:

  • The integrated care pathway (ICP) effectively enhanced patient education and reduced prescribing errors in pediatric acute asthma/wheeze cases.
  • The ICP demonstrated a modest reduction in length of stay, particularly when discharge criteria were followed, but did not impact recovery time.
  • Further research is needed to evaluate the impact of ICPs on healthcare staff workload.
Abstract

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