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Improving Inpatient Asthma Management: The Implementation and Evaluation of a Pediatric Asthma Clinical Pathway
Teresa G Magruder1, Sridaran Narayanan1, Susan Walley1
1Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Ala.; Respiratory Therapy Department, Children's of Alabama, Birmingham, Ala.; Performance Improvement Department, Children's of Alabama, Birmingham, Ala.; and Department of Medicine, University of Alabama at Birmingham, Birmingham, Ala.
Insights
Implementing an inpatient Asthma Clinical Pathway significantly reduced pediatric asthma hospital length of stay (LOS) and costs. This standardized care approach improved asthma management without increasing readmission rates for patients.
Area of Science:
- Pediatric Pulmonology
- Healthcare Quality Improvement
- Clinical Pathway Implementation
Background:
- Asthma exacerbations are a primary cause of pediatric hospitalizations.
- Inconsistent care practices, including bronchodilator use and oxygen management, contribute to variability in patient outcomes.
- There is a need to standardize inpatient asthma care to improve efficiency and patient outcomes.
Purpose of the Study:
- To implement and evaluate a respiratory therapy-driven Asthma Clinical Pathway for inpatient management.
- To standardize care processes for pediatric asthma patients.
- To assess the impact of the pathway on length of stay (LOS), hospital charges, and readmission rates.
Main Methods:
- A respiratory therapy-led Asthma Clinical Pathway was developed with standardized assessments, bronchodilator dosing, and progression protocols.
- A retrospective comparison was conducted between patients managed under the Pathway and a 'Usual Care' cohort during a pilot phase.
- Statistical process control charts analyzed LOS and charges for all asthma admissions over a longer period post-implementation.
Main Results:
- Pathway patients experienced a significant reduction in LOS (0.95 vs. 1.86 days) and charges ($7,413 vs. $11,078) compared to usual care during the pilot.
- Overall asthma admissions showed a decrease in LOS from 2.30 to 1.44 days post-pathway implementation.
- Readmission rates remained statistically similar between Pathway and usual care groups, and charges stabilized.
Conclusions:
- The Asthma Clinical Pathway effectively reduced length of stay and stabilized hospital charges for pediatric asthma admissions.
- The pathway demonstrated a sustainable, widely adopted improvement in inpatient asthma care without adversely affecting readmission rates.
- Standardized, respiratory therapy-driven pathways are valuable tools for optimizing pediatric asthma management.
Introduction:
Asthma exacerbations are a leading cause of pediatric hospitalizations. Despite national guidelines, variability exists in the use and dosing of bronchodilators, oxygen management, and respiratory assessments of patients. We aimed to implement an inpatient Asthma Clinical Pathway (Pathway) to standardize care and reduce length of stay (LOS).
Methods:
A respiratory therapy-driven Pathway was designed for inpatient asthma management. The Pathway included standardized respiratory therapy assessments, bronchodilator dosing, and protocols for progression and clinical worsening. We monitored key process measures. Patients admitted to the Pathway during pilot implementation (March to December 2011) were compared retrospectively with a "Usual Care" cohort admitted during the same period. We compared average LOS, average billed charges per hospitalization (charges), and 30-day readmissions between groups. Statistical process control charts were utilized to analyze LOS and charges for all asthma admissions following Pathway implementation (March 2011 to September 2016). Readmissions and Pathway removals were balancing measures.
Results:
During pilot, Pathway patients (n = 153) compared with "Usual Care" patients (n = 166) had shorter LOS (0.95 versus 1.86 days; P < 0.001) and lower charges ($7,413 versus $11,078; P < 0.001). Readmission rates were not significantly different between groups. LOS for all asthma admissions (n = 3,429) decreased from 2.30 to 1.44 days (P < 0.001) following Pathway implementation. Charges remained stable. The readmission rate (per 100 discharges) for all asthma was 2.42 and not significantly different between Pathway and non-Pathway groups.
Conclusions:
Pathway implementation reduced LOS and stabilized charges while not increasing readmission rates. The Pathway facilitated sustainable widely adopted improvements in asthma care.
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