Our pediatric emergency department (ED), as part of Hemby Children’s Hospital at Novant Health Presbyterian Medical Center, has worked hard over the last year to improve the care of children presenting to the ED with asthma. They implemented a new treatment algorithm for acute asthma symptoms, and we are excited to share the results of their efforts as it has led to several areas of improvement in the care for these patients.
Beginning February of 2018, clinicians followed a new diagnostic and treatment pathway for asthma patients who came to the Hemby Children’s Emergency Department (ED). This was part of an initiative, spearheaded by the American Academy of Pediatrics, that focused on the following goals to help improve the quality and efficiency of care for each and every patient:
- Use of a research-validated, objective scoring system to assess the severity of a child’s symptoms (initiated right away in triage, and repeated throughout courses of treatment and hospital stay)
- Early administration of steroid treatment (within 60 minutes)
- Early administration of additional therapies if indicated (alongside albuterol, the standard first-line treatment) in more severe symptoms
- Reduced use of Chest X-rays, which are often not indicated and do not change the course of treatment for the patient
ED clinicians at Hemby followed this algorithm for 1 year and analyzed the appropriate metrics to determine if it improved patient care and outcomes. They specifically looked at whether the use of the new protocol reduced the need to return to the hospital, the need for ICU admission, and length of stay in the ED or hospital if admitted.
In March of 2019, they sat down and analyzed their data from the past year, and we’re excited to see that their new approach led to positive results across a number of different metrics:
|Steroid Administration within 60 minutes||Improved from 51% to 83%|
|Chest X-ray Use||Decreased from 27% to 13%|
|ED Length of Stay||Decreased (on average) by 10 minutes|
|Hospitalization Length of Stay||Decreased by 12% (during peak season)|
|Readmission to the Hospital within 7 days||Decreased by 67%|
|Transfer into the ICU||Decreased by 50%|
Their hard work and encouraging outcomes have led to ongoing investment in the treatment pathway across both the ED and pediatric hospital departments, as they continue to try and bring the best care to the children of Charlotte and surrounding areas.
We here at MEMA want parents and caretakers of asthmatic patients to know we always strive to take the best care of your child and want to make your and your child’s experience the least stressful as possible. Below are some guidelines to help you know when to bring your child to the ED:
- Wheezing or persistent coughing that does not improve within 15 min of treatments at home.
- You find yourself using rescue treatments every 3 hours or more frequently.
- The child cannot speak comfortably in full sentences, or cannot comfortably eat or drink.
- The child appears to be working harder to breathe, which is often evident in the way he or she is using muscles when breathing (the muscles above the collar bone, between the ribs, or below the ribs appear to pull in when the child breathes in).
- A change in the child’s color (this can range from pale to blue-greyish, and is often seen in the face, around the lips, or in the fingernails).
- If your child seems more fatigued or tired than is normal.
Asthma symptoms can progress quickly, so if you see any of these signs or you have any concern about a child’s breathing or symptoms, do not delay care. Please call 911 or proceed to the nearest ED without hesitation.