A Respiratory Therapist-Driven Asthma Pathway Reduced Hospital Length of Stay in the Pediatric Intensive Care Unit.

Miller, Andrew G

Haynes, Kaitlyn E

Gates, Rachel M

Zimmerman, Kanecia O

Heath, Travis S

Bartlett, Kathleen W

McLean, Heather S

Rehder, Kyle J

2020-04-01T14:53:32Z

2020-04-01T14:53:32Z

2019-11

2020-04-01T14:53:32Z

BACKGROUND:Asthma is a common reason for admissions to the pediatric intensive care unit (PICU). Since June 2014, our institution has used a pediatric asthma clinical pathway for all patients, including those in PICU. The pathway promotes respiratory therapist-driven bronchodilator weaning based on the Modified Pulmonary Index Score (MPIS). This pathway was associated with decreased hospital length of stay (LOS) for all pediatric asthma patients; however, the effect on PICU patients was unclear. We hypothesized that the implementation of a pediatric asthma pathway would reduce hospital LOS for asthmatic patients admitted to the PICU. METHODS:We retrospectively reviewed the medical records of all pediatric asthma subjects 2-17 y old admitted to our PICU before and after pathway initiation. Primary outcome was hospital LOS. Secondary outcomes were PICU LOS and time on continuous albuterol. Data were analyzed using the chi-square test for categorical data, the t test for normally distributed data, and the Mann-Whitney test for nonparametric data. RESULTS:A total of 203 eligible subjects (49 in the pre-pathway group, 154 in the post group) were enrolled. There were no differences between groups for age, weight, gender, home medications, cause of exacerbation, medical history, or route of admission. There were significant decreases in median (interquartile range) hospital LOS (4.4 [2.9-6.6] d vs 2.7 [1.6-4.0] d, P < .001), median PICU LOS (2.1 [1.3-4.0] d vs 1.6 [0.8-2.4] d, P = .003), and median time on continuous albuterol (39 [25-85] h vs 27 [13-42] h, P = .001). Significantly more subjects in the post-pathway group were placed on high-flow nasal cannula (32% vs 6%, P = .001) or noninvasive ventilation (10% vs 4%, P = .02). CONCLUSION:The implementation of an asthma pathway was associated with decreased hospital LOS, PICU LOS, and time on continuous albuterol. There was also an increase in the use of high-flow nasal cannula and noninvasive ventilation after the implementation of this clinical pathway.

respcare.06626

0020-1324

1943-3654

https://hdl.handle.net/10161/20339

eng

Daedalus Enterprises

Respiratory care

10.4187/respcare.06626

asthma

asthma pathway

high-flow nasal cannula

propensity score matching

protocol

quality improvement

respiratory therapy

status asthmaticus

A Respiratory Therapist-Driven Asthma Pathway Reduced Hospital Length of Stay in the Pediatric Intensive Care Unit.

Journal article

Zimmerman, Kanecia O|0000-0003-3748-6932

McLean, Heather S|0000-0003-4901-8298

1325

1332

11

School of Medicine

Duke

Staff

Duke Clinical Research Institute

Pediatrics, Critical Care Medicine

Institutes and Centers

Pediatrics

Clinical Science Departments

Published

64