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A Respiratory Therapist-Driven Asthma Pathway Reduced Hospital Length of Stay in the Pediatric Intensive Care Unit.
Respir Care. 2019 Nov; 64(11):1325-1332.RC

Abstract

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.

Authors+Show Affiliations

Respiratory Care Services at Duke University Medical Center, Durham, North Carolina. andrew.g.miller@duke.edu.Respiratory Care Services at Duke University Medical Center, Durham, North Carolina.Respiratory Care Services at Duke University Medical Center, Durham, North Carolina.Division of Pediatric Critical Care Medicine, Duke University Medical Center, Durham, North Carolina.Department of Pharmacy, Duke University Medical Center, Durham, North Carolina.Division of Pediatric Hospital Medicine, Duke University Medical Center, Duke University Medical Center, Durham, North Carolina.Division of Pediatric Hospital Medicine, Duke University Medical Center, Duke University Medical Center, Durham, North Carolina.Division of Pediatric Critical Care Medicine, Duke University Medical Center, Durham, North Carolina.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31088987

Citation

Miller, Andrew G., et al. "A Respiratory Therapist-Driven Asthma Pathway Reduced Hospital Length of Stay in the Pediatric Intensive Care Unit." Respiratory Care, vol. 64, no. 11, 2019, pp. 1325-1332.
Miller AG, Haynes KE, Gates RM, et al. A Respiratory Therapist-Driven Asthma Pathway Reduced Hospital Length of Stay in the Pediatric Intensive Care Unit. Respir Care. 2019;64(11):1325-1332.
Miller, A. G., Haynes, K. E., Gates, R. M., Zimmerman, K. O., Heath, T. S., Bartlett, K. W., McLean, H. S., & Rehder, K. J. (2019). A Respiratory Therapist-Driven Asthma Pathway Reduced Hospital Length of Stay in the Pediatric Intensive Care Unit. Respiratory Care, 64(11), 1325-1332. https://doi.org/10.4187/respcare.06626
Miller AG, et al. A Respiratory Therapist-Driven Asthma Pathway Reduced Hospital Length of Stay in the Pediatric Intensive Care Unit. Respir Care. 2019;64(11):1325-1332. PubMed PMID: 31088987.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A Respiratory Therapist-Driven Asthma Pathway Reduced Hospital Length of Stay in the Pediatric Intensive Care Unit. AU - Miller,Andrew G, AU - Haynes,Kaitlyn E, AU - Gates,Rachel M, AU - Zimmerman,Kanecia O, AU - Heath,Travis S, AU - Bartlett,Kathleen W, AU - McLean,Heather S, AU - Rehder,Kyle J, Y1 - 2019/05/14/ PY - 2019/5/16/pubmed PY - 2020/8/21/medline PY - 2019/5/16/entrez KW - asthma KW - asthma pathway KW - high-flow nasal cannula KW - propensity score matching KW - protocol KW - quality improvement KW - respiratory therapy KW - status asthmaticus SP - 1325 EP - 1332 JF - Respiratory care JO - Respir Care VL - 64 IS - 11 N2 - 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. SN - 1943-3654 UR - https://www.unboundmedicine.com/medline/citation/31088987/A_Respiratory_Therapist_Driven_Asthma_Pathway_Reduced_Hospital_Length_of_Stay_in_the_Pediatric_Intensive_Care_Unit_ L2 - http://rc.rcjournal.com/cgi/pmidlookup?view=short&amp;pmid=31088987 DB - PRIME DP - Unbound Medicine ER -