Improving Guideline-Based Care of Acute Asthma in a Pediatric Emergency Department

Pediatrics. 2016 Nov;138(5):e20153339. doi: 10.1542/peds.2015-3339.


Background and objective: Rapid repetitive administration of short-acting β-agonists (SABA) is the most effective means of reducing acute airflow obstruction in asthma. Little evidence exists that assesses process measures (ie, timeliness) and outcomes for asthma. We used quality improvement (QI) methods to improve emergency department care in accordance with national guidelines including timely SABA administration and use of asthma severity scores.

Methods: The Model for Improvement was used and interventions were targeted at 4 key drivers: knowledge, engagement, decision support, and workflow enhancement. Time series analysis was performed and outcomes assessed on statistical process control charts.

Results: Asthma severity scoring increased from 0% to >95% in triage and to >75% for repeat scores. Time to first SABA (T1) improved by 32.8 minutes (47%). T1 for low severity patients improved by 17.6 minutes (28%). T1 for high severity patients improved by 3.1 minutes to 18.1 minutes (15%). Time to third SABA (T3) improved by 30 minutes (24%). T3 for low severity patients improved by 42.5 minutes (29%) and T3 for high severity patients improved by 21 minutes (23%). Emergency department length of stay for low severity patients discharged to home improved by 29.3 minutes (15%). The number of asthma-related visits between 48-hour return hospitalizations increased from 114 to 261. The admission rate decreased 6.0%.

Conclusions: We implemented standardized asthma severity scoring with high rates of compliance, improved timely administration of β-agonist treatments, demonstrated early improvements in Emergency department length of stay, and reduced admission rates without increasing unplanned return admissions.

MeSH terms

  • Adolescent
  • Adrenergic beta-2 Receptor Agonists / therapeutic use
  • Asthma / drug therapy*
  • Child
  • Child, Preschool
  • Clinical Audit
  • Emergency Service, Hospital*
  • Guideline Adherence
  • Hospitals, Pediatric
  • Humans
  • Outcome and Process Assessment, Health Care*
  • Patient Admission / statistics & numerical data
  • Practice Guidelines as Topic
  • Quality Improvement*
  • Severity of Illness Index
  • Triage
  • Wisconsin


  • Adrenergic beta-2 Receptor Agonists