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Improving Administration of Prehospital Corticosteroids for Pediatric Asthma
Lauren C Riney1, Hamilton Schwartz1, Eileen Murtagh Kurowski1
1Division of Emergency Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, College of Medicine, Cincinnati, Ohio.
Insights
Early corticosteroid use in pediatric asthma exacerbations improves outcomes. A new protocol increased prehospital corticosteroid administration in children by 34%, though the 70% target was not met, highlighting implementation barriers.
Area of Science:
- Pediatric Emergency Medicine
- Healthcare Quality Improvement
- Respiratory Illness Management
Background:
- Early systemic corticosteroids improve outcomes in pediatric asthma exacerbations.
- A new emergency medical services (EMS) protocol for prehospital corticosteroid administration was implemented in Southwest Ohio in January 2016.
- The study aimed to increase corticosteroid use from 0% to 70% in pediatric asthma exacerbations within two years.
Purpose of the Study:
- To evaluate the implementation of a new EMS protocol for systemic corticosteroid administration in pediatric asthma exacerbations.
- To assess the impact of quality improvement interventions on prehospital corticosteroid use.
- To identify barriers to protocol implementation in pediatric prehospital care.
Main Methods:
- Utilized plan-do-study-act cycles for intervention testing and refinement.
- Implemented EMS outreach, education, protocol clarification, and feedback mechanisms.
- Tracked adherence using statistical process control charts for 256 eligible pediatric asthma exacerbation encounters (ages 3-16).
Main Results:
- Following targeted education, a 34% shift in corticosteroid administration was observed at high-volume EMS stations.
- This increased administration rate has been sustained for 28 months.
- The study demonstrated a significant increase in prehospital corticosteroid use, but did not reach the 70% target.
Conclusions:
- Quality improvement initiatives can enhance prehospital corticosteroid administration for pediatric asthma exacerbations.
- Barriers to pediatric prehospital protocol implementation exist and can be addressed with improvement tools.
- While the 70% target was not achieved, the methodology led to sustained improvements.
Abstract:
Early administration of systemic corticosteroids for asthma exacerbations in children is associated with improved outcomes. Implementation of a new emergency medical services (EMS) protocol guiding the administration of systemic corticosteroids for pediatric patients with asthma exacerbations went into effect in January 2016 in Southwest Ohio. Our SMART aim was to increase the proportion of children receiving systemic prehospital corticosteroids for asthma exacerbations from 0% to 70% over 2 years.
Methods:
Key drivers were derived and tested using multiple plan-do-study-act cycles. Interventions included community EMS outreach and education, improved clarity in the prehospital protocol language, distribution of pocket-sized educational cards, and ongoing individualized EMS agency feedback on protocol adherence. Eligible patients included children age 3-16 years, who were transported by EMS to the pediatric emergency department with diagnoses consistent with asthma exacerbation. Manual chart review assessed eligibility to receive prehospital corticosteroids. Statistical process control charts tracked adherence to corticosteroid recommendations.
Results:
A total of 256 encounters met the criteria for receiving prehospital corticosteroids for pediatric asthma exacerbations between January 1, 2016, and April 30, 2019. Special cause variation was demonstrated following education at high-volume EMS stations, and the centerline shifted to 34%. This shift has been sustained for 28 months.
Conclusion:
Improvement methodology increased prehospital corticosteroid administration for pediatric asthma exacerbations, although we failed to achieve our aim of increasing use to 70%. Many barriers exist in pediatric prehospital protocol implementation, many of which can be improved with quality improvement tools.
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