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How commonly are children hospitalized for asthma eligible for care in alternative settings?
K M McConnochie1, M J Russo, J T McBride
1Department of Pediatrics, University of Rochester School of Medicine, NY, USA.
Insights
Over 70% of pediatric asthma hospitalizations could be managed in alternative settings. This includes short-stay units or home care with oxygen and nebulizer treatments, reducing hospital stays.
Area of Science:
- Pediatric Pulmonology
- Healthcare Management
- Clinical Outcomes Research
Background:
- Acute asthma exacerbations in children frequently lead to hospitalization.
- Current management protocols may involve longer hospital stays than necessary for some patients.
Purpose of the Study:
- To determine the proportion of pediatric asthma hospitalizations suitable for alternative care settings.
- To identify key clinical indicators for successful management outside traditional inpatient units.
Main Methods:
- Analysis of 2028 pediatric asthma hospitalizations (1991-1995) in Rochester, NY.
- Retrospective review of medical records for a random sample (443 episodes) to assess medication frequency, oxygen saturation, and clinical course.
- Evaluation of hospital length of stay for all admissions.
Main Results:
- Most children (over 70%) did not require prolonged hospitalization.
- Frequent nebulized medication treatments were administered for an average of 2 nursing shifts, but hospital stays averaged 4.3 shifts.
- Clinical deterioration requiring critical care transfer was rare (0.7% of cases).
Conclusions:
- A significant majority of pediatric asthma hospitalizations are candidates for alternative care settings.
- Alternative settings can provide necessary treatments like supplemental oxygen and nebulized medications with close nursing observation.
- This approach has the potential to optimize resource utilization and reduce healthcare costs.
Objective:
To estimate the proportion of children hospitalized for acute asthma exacerbation who might be cared for successfully in alternative settings such as short-stay units or in-home nursing.
Design:
Descriptive study based on analysis of hospital discharge files and on retrospective medical record review of a random sample of asthma hospitalizations.
Methods:
The 2028 asthma hospitalizations between 1991 and 1995 for children (aged <19 years) dwelling in Rochester, NY, were studied. Measures included the duration of frequent administration of nebulized medication (2 or more times in a 4-hour period), worst oxygen saturation levels, deterioration, and hospital length of stay. Oxygen saturation values and nebulized medication frequency were determined by hospital record review on a random sample of 443 asthma episodes. Length of stay was available for all admissions.
Results:
Worst oxygen saturation following hospital admission was 95% or greater, 90% to 94%, and less than 90% for 21.3%, 51.6%, and 27.1% of episodes, respectively. Children received frequent nebulized medication treatments for a mean of 2.0 nursing shifts (8 hours per shift), although they remained hospitalized, on average, for 4.3 nursing shifts longer. Deterioration to a critical level of severity was uncommon. Among children initially admitted to the regular pediatric inpatient unit, only 0.7% subsequently deteriorated to the point that they were transferred to the critical care unit.
Conclusion:
More than 70% of asthma hospitalizations in this community could be cared for in alternative settings with supplemental oxygen, nebulized medication treatments, and close nursing observation provided, in most cases, for 2 nursing shifts.