Improving care for acute asthma exacerbation in the Pediatric ED
Project Description: Roughly 7.8% of the US population has been diagnosed as having asthma, with 8.4% of that population falling between the ages of 0 and 17 years per the 2015 National Health Interview Survey. Recent reviews of healthcare utilization list acute asthma symptoms, ranging from non-severe to life-threatening, as one of the most common presenting complaints at emergency departments comprising nearly 2 million visits as described by data collected in the annual, nationally representative 2014 National Hospital Ambulatory Medical Care Survey. The state of Florida alone is estimated to carry 8% of the asthma community, challenging local healthcare providers to ensure the most efficient methods of asthma care delivery are in place. While standards of care for treating acute asthma symptoms have been widely mastered across adult and pediatric hospitals alike, there still remains significant variation in the protocols for clinical assessment and intervention delivery. Numerous barriers to expeditious care have been identified across multiple studies as well, including ED overcrowding, young patient age and less severe presenting symptoms. Rowe et al. conducted a Cochrane Database Review which linked improved outcomes, as defined by hospital admission rates, to systemic corticosteroid administration time within 60 minutes of ED arrival. Through efforts to optimize asthma exacerbation treatment, other centers have demonstrated improved medication adminstration times via RN-initiated protocols for both nebulized medications and systemic corticosteroids. Given the significant asthma burden within our state and rates of exacerbation treatment at the UF Health Pediatric Emergency Department, attention is being directed at local care practices with the goal of determining the most appropriate interventions to optimize care for our community. ED course for patients presenting with acute asthma symptoms during the months of October and November 2017 will be closely examined to determine practice patterns related to triage, formal assessment and intervention completion, as well as the rates of discharge versus admission. While each aspect of patient care will be closely examined to optimize time to medication delivery, there will be a specific focus on time to corticosteriod administration as research suggests this intervention to be most contributory in improving outcomes.
QPI: Brandy, Johnson, (firstname.lastname@example.org)
Advisors: Maritza, Plaza Verduin, (email@example.com)
UF Health Big Aims: Reduce Variation None
MeSH Keywords: Albuterol, Asthma, Prednisolone, Prednisone, Status Asthmaticus, Work of Breathing, Metered Dose Inhalers, Methylprednisolone