Reducing Delays in Therapy for Children With Asthma Admitted From the Emergency Department

Abstract

Background: A score-based asthma pathway is utilized at Arkansas Children’s Hospital to manage and treat asthma exacerbation in children. The pathway is initiated by the physician and completed by the respiratory therapist (RT) who assesses and provides treatment based on the score. Frequency of treatments and reassessment is dependent upon the score. When admission from the Emergency Department (ED) for asthma exacerbation occurs, an inpatient RT coordinator evaluates the patient upon arrival to the medical-surgical ward. Delays in treatment and escalations of care have occurred due to waiting on bed placement. During this time, inpatient orders are held until arrival to the ward and the coordinator is unable to assess. We hypothesized that if the RT coordinator evaluated the patient before transferring to the inpatient ward, delays in care would be decreased. Methods: The study was approved by the local Institutional Review Board. Several process changes were made including improved communication between the ED admitting nurse and the RT coordinator, patient assessment by the coordinator in the ED, and monitoring of the ED tracker board. A retrospective and prospective chart review was utilized to compare the length of time between rescoring in the ED and on the inpatient ward before and after process changes were made. Children with asthma admitted to the pediatric intensive care unit (PICU) were excluded as assessment is done by the RT assigned to the unit rather than the coordinator. Results: There were 261 children with asthma admitted from the ED between June 2018 and January 2019. Of those, 95 were treated before changes were made while 114 where managed with new process. Fifty-two were excluded due to transfer to the PICU. The baseline for time between rescoring in the ED and on the inpatient ward was 132 minutes. Under the new process, the time was reduced to 81.48 minutes which resulted in a 38% decrease in waiting time. Conclusions: Implementing process changes for children with asthma admitted from the ED resulted in a significant reduction in the wait time for care.