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Continuous Aerosolized Albuterol Treatment for Status Asthmaticus on the General Care Floor: A Quality Improvement

Kailey A Remien1, Charles Hardy2, Karen Allen3,4

  • 1From the Division of Critical Care Medicine, Nationwide Children's Hospital, Columbus, Ohio.

Pediatric Quality & Safety
|July 17, 2026
PubMed

Insights

Continuous aerosolized albuterol (CAA) can be safely given on general care floors for pediatric asthma, reducing intensive care unit (PICU) hours. This quality improvement project demonstrated successful expansion of CAA use outside the PICU.

Area of Science:

  • Pediatric pulmonology
  • Quality improvement science
  • Healthcare management

Background:

  • Asthma is a major cause of pediatric hospitalization in the US.
  • Continuous aerosolized albuterol (CAA) is effective for severe asthma exacerbations but typically limited to intensive care settings.
  • Expanding CAA to general care floors can improve resource utilization.

Purpose of the Study:

  • To assess the feasibility and safety of expanding Continuous Aerosolized Albuterol (CAA) use to the general care floor (GCF) for pediatric patients with status asthmaticus.
  • To monitor treatment uptake, adherence to protocol, and safety outcomes of GCF-based CAA.
  • To evaluate the impact on Pediatric Intensive Care Unit (PICU) resource utilization.

Main Methods:

  • A single-center quality improvement project involving children aged 2-18 years with status asthmaticus.
  • Implementation of a structured protocol, staff education, and electronic health record updates.
  • Monitoring of GCF CAA hours, PICU/emergency transfers, hypotension, and ED length of stay.

Main Results:

  • Continuous aerosolized albuterol (CAA) use on the general care floor (GCF) accounted for 17% of total hospital CAA, exceeding the 10% target.
  • 72 patients were safely treated on the GCF, with 31% requiring PICU transfer (none emergent).
  • The intervention saved 1,017 PICU hours and an estimated $275,600 in costs, without increasing ED length of stay.

Conclusions:

  • Continuous aerosolized albuterol (CAA) can be safely administered on the general care floor (GCF) for pediatric asthma exacerbations.
  • A structured protocol facilitates safe GCF implementation, reducing PICU resource needs.
  • This approach optimizes resource allocation without compromising emergency department efficiency.
Abstract

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