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An Asthma Protocol Improved Adherence to Evidence-Based Guidelines for Pediatric Subjects With Status Asthmaticus in
Andrew G Miller1, Moira E Breslin2, Leslie C Pineda3
1Department of Respiratory Care Services andrew.g.miller@duke.edu.
Insights
An evidence-based asthma protocol improved adherence to National Institutes of Health guidelines for pediatric patients with status asthmaticus. The protocol enhanced the efficiency of administering bronchodilator and corticosteroid therapies in the emergency department.
Area of Science:
- Pediatric Emergency Medicine
- Pulmonology
- Clinical Quality Improvement
Background:
- Suboptimal adherence to evidence-based asthma guidelines was observed in a pediatric emergency department.
- Asthma exacerbations, particularly status asthmaticus, require timely and guideline-adherent treatment.
Purpose of the Study:
- To evaluate the impact of an evidence-based asthma protocol on treatment timeliness and guideline adherence.
- To assess improvements in the management of pediatric patients with status asthmaticus.
Main Methods:
- Retrospective analysis of pediatric patients with status asthmaticus before and after protocol implementation (February 2012).
- Inclusion of subjects receiving continuous albuterol treatment.
- Primary outcomes: time to bronchodilator and corticosteroid therapy, and ipratropium bromide administration.
Main Results:
- Post-protocol implementation showed increased administration of bronchodilators within 30 minutes (77% vs 60%) and corticosteroids within 60 minutes (77% vs 62%).
- Significantly higher rates of ipratropium bromide use were observed post-protocol (87% vs 55%).
- No significant differences in mean time to first treatment or emergency department length of stay were found.
Conclusions:
- The implemented asthma protocol led to improved adherence to National Institutes of Health guidelines.
- The protocol enhanced the efficiency of administering essential asthma therapies in the emergency setting.
- This quality improvement initiative positively impacted pediatric asthma exacerbation management.
Background:
In our institution's pediatric emergency department, adherence to evidence-based asthma guidelines was noted to be suboptimal for patients with asthma exacerbations. We hypothesized that an evidence-based asthma protocol would improve time to treatment and adherence to National Institutes of Health guidelines for patients presenting to the emergency department with status asthmaticus.
Methods:
Subjects at our institution were retrospectively identified through an electronic medical record search following institutional review board approval. The asthma protocol was initiated in February 2012. All pediatric subjects who received continuous albuterol in the emergency department before (February 26, 2009, to February 22, 2012, n = 193) and after (February 23, 2012, to December 31, 2012, n = 68) protocol initiation were analyzed. The post-protocol data were collected as part of routine quality assurance monitoring with a target of 60 post-protocol subjects. Subjects were identified at the end of each month, which resulted in a total of 68 subjects being included. Primary outcomes measured included time to initial treatment with inhaled bronchodilator therapy, time to treatment with systemic corticosteroids, and total number of ipratropium bromide treatments delivered.
Results:
Two-hundred sixty-one subjects (7.1 ± 4.6 y of age, 66% male) were included. Demographics were similar in the pre- and post-protocol groups. Compared with the pre-protocol group, more subjects in the post-protocol group received bronchodilators within 30 min (60% vs 77%, P = .02), at least one dose of ipratropium bromide (55% vs 87%, P < .001), 3 doses of ipratropium bromide (14% vs 54%, P < .001), and corticosteroids within 60 min (62% vs 77%, P = .04). There were no statistically significant differences between the pre- and post-protocol cohorts in the mean time to first bronchodilator treatment (32 ± 41 vs 26 ± 52 min, P = .34), mean time to corticosteroid administration (74 ± 68 vs 54 ± 63 min, P = .06), or mean emergency department length of stay (342 ± 143 vs 364 ± 183 min, P = .31).
Conclusions:
An asthma protocol resulted in improved adherence to National Institutes of Health guidelines in children with status asthmaticus and improved efficiency in the administration of rescue bronchodilator and systemic corticosteroid therapy.
