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Implementing a Standardized Clinical Pathway Leads to Reduced Asthma Admissions and Health Care Costs
Elisha M McCoy1,2, Rudy J Kink1,3, La Precious L Harrold1,2
1Le Bonheur Children's Hospital, Memphis, Tenn.
Insights
A standardized clinical pathway for pediatric asthma exacerbations significantly reduced emergency department treatment times and hospital admissions. This quality improvement initiative also resulted in substantial cost savings for the institution.
Area of Science:
- Pediatric Emergency Medicine
- Quality Improvement Science
- Healthcare Management
Background:
- Asthma exacerbations are a primary cause of pediatric hospitalizations in the U.S.
- Emergency department overcrowding can delay critical asthma treatment.
- Standardized clinical pathways are proven to enhance adherence to evidence-based care.
Purpose of the Study:
- To develop and implement a standardized care pathway for pediatric asthma exacerbations.
- To decrease treatment initiation time in the emergency department.
- To reduce hospital admission rates for childhood asthma.
Main Methods:
- Process mapping identified current care delivery barriers.
- Plan-Do-Study-Act cycles informed pathway development based on respiratory scores.
- Run charts analyzed data to guide iterative interventions.
Main Results:
- Steroid administration occurred within 60 minutes for pediatric asthma patients.
- Hospital admissions decreased from 24% to 17% during the intervention.
- Estimated institutional cost savings exceeded $230,000 over two years.
Conclusions:
- A multidisciplinary approach to a standardized asthma pathway improves pediatric care.
- Reduced treatment times and hospital admissions were achieved.
- Standardized pathways offer significant benefits for common childhood illnesses.
Introduction:
Asthma exacerbations are 1 of the leading causes of hospital admissions in children in the United States. High volumes in the emergency department can lead to delayed treatment. Several studies have shown that implementation of a standardized clinical pathway can improve adherence to evidence-based standards. The purpose of our quality improvement project was to develop a standardized pathway of care for children with asthma exacerbations to improve time to treatment and reduce admissions.
Methods:
The team used process mapping to review the current process of care for patients with asthma exacerbations presenting to the Emergency Department. After identification of several barriers, the team used plan-do-study-act cycles to develop a standardized clinical pathway of care for children based on their respiratory clinical score. Further interventions occurred after data collection and analyzation through run charts.
Results:
Implementation of a standardized clinical pathway for children with asthma presenting to the Emergency Department resulted in treatment with steroids in less than 60 minutes. Overall admissions were decreased from an average of 24% to 17% throughout the intervention period. We estimated cost savings for the institution at over $230,000 for the 2 years after implementation of the pathway.
Conclusions:
Using a multidisciplinary team approach to develop a standardized clinical pathway for a common childhood illness like asthma can result in reduced time to treatment and admissions.
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