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Standardized Protocol Is Associated With a Decrease in Continuous Albuterol Use and Length of Stay in Critical Status
Elliot Melendez1,2, Danielle Dwyer1, Daria Donelly3
1Division of Medicine Critical Care, Boston Children's Hospital, Harvard Medical School Boston, MA.
Insights
A quality improvement protocol successfully reduced continuous albuterol duration and hospital stay for critically ill children with severe asthma. This approach improved patient outcomes without increasing adverse events or readmissions.
Area of Science:
- Pediatric Critical Care Medicine
- Respiratory Medicine
- Quality Improvement Science
Background:
- Severe status asthmaticus in children necessitates intensive care, often involving continuous albuterol administration.
- Prolonged treatment duration and hospital stays are significant concerns in managing these critically ill pediatric patients.
Purpose of the Study:
- To decrease the duration of continuous albuterol therapy.
- To reduce hospital length of stay for critically ill children experiencing severe status asthmaticus.
- To evaluate the impact of a standardized quality improvement protocol on treatment metrics and patient outcomes.
Main Methods:
- An observational prospective study was conducted from September 2012 to May 2016 in a pediatric intensive care and intermediate care unit.
- A standardized, iterative quality improvement protocol was implemented, focusing on optimizing continuous albuterol and overall hospital stay.
- The protocol underwent three revisions to refine therapy escalation and weaning strategies, with adverse events and readmissions as balancing measures.
Main Results:
- The study included 385 patients treated under the protocol, with baseline data from 150 patients. No significant differences in age, asthma severity, or gender were observed between groups.
- Statistical process control charting demonstrated a significant reduction in the mean duration of continuous albuterol from 24.9 to 17.5 hours.
- The mean hospital length of stay decreased substantially from 76 to 49 hours, with no significant increase in adverse events or readmissions.
Conclusions:
- Implementation of a quality improvement protocol is effective in reducing continuous albuterol duration in critically ill children with status asthmaticus.
- The protocol also significantly decreased hospital length of stay for these patients.
- This quality improvement initiative achieved desired outcomes without compromising patient safety, as indicated by stable adverse event and readmission rates.
Objectives:
The primary aim of this study was to reduce duration of continuous albuterol and hospital length of stay in critically ill children with severe status asthmaticus.
Design:
Observational prospective study from September 2012 to May 2016.
Setting:
Medicine ICU and intermediate care unit.
Patients:
Children greater than 2 years old with admission diagnosis of status asthmaticus admitted on continuous albuterol and managed via a standardized protocol.
Interventions:
The protocol was an iterative algorithm for escalation and weaning of therapy. The algorithm underwent three revisions. Iteration 1 concentrated on reducing duration on continuous albuterol; iteration 2 concentrated on reducing hospital length of stay; and iteration 3 concentrated on reducing helium-oxygen delivered continuous albuterol. Balancing measures included adverse events and readmissions.
Measurements And Results:
Three-hundred eighty-five patients were treated as follows: 123, 138, and 124 in iterations 1, 2, and 3, respectively. Baseline data was gathered from an additional 150 patients prior to protocol implementation. There was no difference in median age (6 vs 8 vs 7 vs 7 yr; p = 0.130), asthma severity score (9 vs 9 vs 9 vs 9; p = 0.073), or female gender (42% vs 41% vs 43% vs 48%; p = 0.757). Using statistical process control charts, the mean duration on continuous albuterol decreased from 24.9 to 17.5 hours and the mean hospital length of stay decreased from 76 to 49 hours. There was no difference in adverse events (0% vs 1% vs 4% vs 0%; p = 0.054) nor in readmissions (0% vs 0% vs 1% vs 2%; p = 0.254).
Conclusions:
Implementation of a quality improvement protocol in critically ill patients with status asthmaticus was associated with a decrease in continuous albuterol duration and hospital length of stay.
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