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Implementation of a Children's Safe Asthma Discharge Care Pathway Reduces the Risk of Future Asthma Attacks in
Lesley Kennedy1, Gillian Gallagher1, Barbara Maxwell1
1Royal Belfast Hospital for Sick Children, Belfast Health and Social Care Trust, Belfast, United Kingdom.
Insights
A new safe asthma discharge care pathway (SADCP) improved children's inhaler technique and action plan adherence. This led to a significant reduction in emergency asthma visits and oral corticosteroid use within a year.
Area of Science:
- Pediatric Emergency Medicine
- Respiratory Medicine
- Healthcare Quality Improvement
Background:
- Frequent emergency department (ED) and out-of-hours (OoH) visits for acute asthma in children indicate suboptimal follow-up care.
- This increases the risk of recurrent asthma exacerbations and attacks in pediatric populations.
- A safe asthma discharge care pathway (SADCP) was developed to address these gaps in pediatric asthma management.
Purpose of the Study:
- To develop, implement, and evaluate the outcomes of a novel safe asthma discharge care pathway (SADCP).
- To improve adherence to asthma action plans and correct inhaler technique in children post-discharge.
- To reduce the frequency of asthma-related emergency visits and oral corticosteroid use in children with recurrent asthma exacerbations.
Main Methods:
- Retrospective evaluation of the SADCP implemented in a pediatric hospital setting.
- Utilized the Teach-to-Goal educational methodology for inhaler technique and personalized asthma action plan (PAAP) mastery.
- Children with frequent asthma attacks were enrolled upon ED or ward discharge, with follow-up training sessions over 8 weeks.
Main Results:
- Pathway entry showed low rates of correct inhaler technique (13%) and PAAP possession (10%).
- Post-pathway, all children achieved correct inhaler technique and PAAP actionability.
- One-year post-pathway, adherence to inhaled corticosteroids improved significantly (51% >80%, 95% >50%), with a median reduction of zero ED/OoH asthma attendances and oral corticosteroid courses.
Conclusions:
- Implementing a structured asthma care pathway with Teach-to-Goal training and early reviews effectively reduces future asthma attack risk.
- The SADCP demonstrates significant improvements in pediatric asthma management, leading to better adherence and fewer acute exacerbations.
- This pathway offers a scalable model for improving asthma care outcomes in both specialized and general pediatric units.
Background:
Many children attend Emergency Departments (ED) and Out of Hours (OoH) frequently for acute asthma. Follow up care is often suboptimal leaving these children at risk of a future attacks. We report on the development, implementation and evaluation of a safe asthma discharge care pathway (SADCP).
Methods:
This is a retrospective report on the development, implementation and evaluation of outcomes of a SADCP. The pathway was based on the Teach-to-goal educational methodology that supported the mastery correct inhaler technique and ability to action the personalized asthma action plan (PAAP). Children with frequent asthma attacks were entered as they were discharged from the Emergency Department or ward. The first training session occurred within 1-3 weeks of the index asthma attack with 2 further sessions in the following 8 weeks. Children exiting the pathway were discharged either back to primary care or to a hospital clinic.
Results:
81 children entered the pathway (median age 5 years) with 72 discharged from the ED and 9 from the medical wards of the Royal Belfast Hospital for Sick Children. At pathway entry 13% had correct inhaler technique, 10% had a Personalized Asthma Action Plan (PAAP), and 5% had >80% (45% >50%) repeat refill evidence of adherence to inhaled corticosteroid over the previous 12 months. On pathway exit all children demonstrated correct inhaler technique and were able to action their PAAP. One year later 51% and 95% had refill evidence of >80% and >50% adherence. Comparisons of the 12 months before and 12 months after exit from the pathway the median number of emergency ED or OoH asthma attendances and courses of oral corticosteroids reduced to zero with >75% having no attacks requiring this level of attention. Similar findings resulted when the SADCP was implemented in a district general hospital pediatric unit.
Conclusion:
Implementing an asthma care pathway, using Teach-to-Goal skill training methods and frequent early reviews after an index asthma attack can reduce the future risk of asthma attacks in the next 6 to 12 months.
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