Ensuring Timely Pulmonary Follow-up after an Inpatient Asthma Hospitalization: A Quality Improvement Initiative

Timely outpatient follow-up after hospitalization for asthma exacerbation is essential for ongoing management and preventing future episodes. We identified significant variability in scheduling postdischarge pulmonology follow-up, leading to inconsistent care. This quality improvement initiative aimed to ensure at least 90% of patients admitted for an acute asthma exacerbation who had been seen by the pulmonology team scheduled for an outpatient pulmonary follow-up with an 80% attendance rate within 45 days of hospital discharge.

A multidisciplinary team developed 3 key drivers. Key interventions included developing standardized asthma care guidelines and ensuring timely pulmonary consultation for all patients admitted to the pediatric intensive care unit with asthma exacerbation. The pulmonary team was also notified of patients previously seen by the department who were admitted to the floor for asthma exacerbation. The outcome measures included the percentage of patients admitted with asthma exacerbation scheduled for pediatric pulmonology follow-up appointments within 45 days and the percentage attending those appointments.

The percentage of scheduled appointments increased from 58.7% to 97.3%, and the appointment attendance rate improved from 45.3% to 85.2%. A retrospective review 3 years after the project's implementation showed sustained improvement, with 93% of appointments scheduled and 82.7% attended.

Scheduling pulmonary follow-up appointments before discharge and using active reminders with immediate rescheduling of cancelations improved outpatient visit attendance. Further research is needed to confirm whether timely follow-up enhances asthma control and reduces readmissions.