Discharging Asthma Patients on 3-Hour β-Agonist Treatments: A Quality Improvement Project

Hosp Pediatr. 2018 Dec;8(12):733-739. doi: 10.1542/hpeds.2018-0072. Epub 2018 Nov 1.

Abstract

Objectives: Asthma exacerbations are a leading cause of hospitalization among children. Despite the existence of hospital protocols and national guidelines, little guidance is available regarding appropriate short-acting β-agonist (SABA) frequency discharge criteria. Our aim was to reduce the median length of stay (LOS) for children hospitalized with asthma exacerbations by 4 hours by changing the discharge requirement SABA frequency.

Methods: Multiple plan-do-study-act cycles based on findings in our key driver diagram were used to decrease LOS. Our primary intervention was reducing the SABA administration frequency discharge requirement from every 4 hours to every 3 hours. After a feasibility pilot, this change was implemented throughout the hospital. Our intervention bundle included updating our evidence-based guidelines, electronic health record order sets and note templates, house-wide education, and a new process for respiratory therapists to notify physicians of discharge readiness. Our primary metric was LOS, with 3-, 7-, and 14-day same-cause emergency department (ED) revisits and hospital readmissions as balancing metrics. Statistical process control charts and nonparametric testing were performed for data analysis.

Results: Median hospital LOS was significantly lower in the postintervention period compared with the preintervention period (30.18 vs 36.14 hours respectively; P < .001). Statistical process control charts indicated special cause variation was achieved. No significant differences were observed in rates of ED revisits or hospital readmissions.

Conclusions: Reducing the discharge requirement of SABA frequency from every 4 hours to every 3 hours resulted in a reduction in LOS, with no increase in ED recidivism or hospital readmission rates.

MeSH terms

  • Adrenergic beta-2 Receptor Agonists / therapeutic use*
  • Anti-Asthmatic Agents / therapeutic use*
  • Asthma / drug therapy*
  • Asthma / physiopathology
  • Child
  • Child, Preschool
  • Feasibility Studies
  • Female
  • Forced Expiratory Volume / drug effects*
  • Forced Expiratory Volume / physiology
  • Humans
  • Length of Stay / statistics & numerical data
  • Male
  • Patient Discharge / statistics & numerical data*
  • Pilot Projects
  • Quality Improvement* / standards
  • Treatment Outcome
  • United States / epidemiology

Substances

  • Adrenergic beta-2 Receptor Agonists
  • Anti-Asthmatic Agents