Children’s of Alabama marks an important milestone with the celebration of its Asthma Clinical Pathway’s 10th Anniversary. The quality improvement initiative began in March 2011 with an aim to reduce inpatient asthma length of stay through the delivery of evidence-based excellent acute asthma care.
Pediatric asthma is a common chronic disease and a leading cause of pediatric hospitalization. At the time we were starting this process, there were several hundred asthma admissions annually with inpatient asthma length of stay and hospital charges were increasing.
The Asthma Clinical Pathway was developed by a team that included physicians from UAB’s Division of Pediatric Pulmonary and Sleep Medicine, Division of Pediatric Hospital Medicine, Division of Academic General Pediatrics and Division of Pediatric Emergency Medicine, in addition to Children’s Respiratory Therapy Department, Pharmacy Department, Nursing Services, Patient Placement Coordinators, Health and Safety Information Department and Pediatric Stimulation Center.
The pathway has helped improve inpatient asthma care from admission to discharge with its standardized care process and discharge criteria. Within the first two years of implementation, Children’s met the national benchmark for reducing hospital stays to two days or less.
Prior to its development, inpatient care involved a direct hands-on physician approach without consistent treatment protocols or evidence-based data. Now, physicians are able to place a patient on the pathway allowing respiratory therapists to administer the proven standard care.
My colleague, Robert Park, Children’s administrative director of Respiratory Care recently said: “The Asthma Clinical Pathway enables us to utilize respiratory therapy resources more efficiently. We are able to assess, treat and adjust patient therapy as needed following the pathway guidelines. The provider is always available if there are any concerns or if there is a need to remove a patient from the pathway. Evaluation of the data we collect allows us to identify opportunities for improvement and implement changes that enhance outcomes. We have been able to shorten length of stay, get patients better quicker, and get them home sooner.”
Through ongoing collaboration, the team has worked to maintain asthma length of two days without increased seven-day or 30-day readmission rates. Since implementation, over 3,800 patients have been admitted to the pathway. We are pleased we have been successful in sustaining our improvement efforts. I credit Children’s Respiratory Therapy department for much of the pathway’s ongoing success. Their team oversees day-to-day pathway management, staff training, and data collection. Due to their efforts, we have extensive data to help us identify areas for continued improvement and to quickly identify care variations.
As an extension of the inpatient pathway, partners from Respiratory Therapy, Division of Pulmonary and Sleep Medicine, and Hospital Medicine care coordinators developed a daily asthma education class to standardize disease management education for inpatients and build a foundation for improved chronic disease management. Over 7,000 patients and caregivers have participated in asthma education since August 2011. If families understand the importance of successful outpatient chronic disease management, we can collaborate with them to decrease their hospitalizations, help them stay in school and keep parents from missing work.
Although the COVID-19 Pandemic has provided challenges in hospital settings, the Pulmonary Division is establishing new ways to continue educating families by working with Children’s IT team. The success of the pathway and the education provided has been the result of an impressive multidisciplinary team effort.