Abstract
Background: Asthma is the most common chronic illness in children. Poorly controlled asthma increases likelihood of an asthma exacerbation resulting in an emergency department visit or hospitalization. High-risk asthma patients are defined at Children’s Hospital Colorado as having frequent exacerbations that result in 2 or more emergency department/urgent care (ED/UC) visits or a hospital admission in the past 12 months. Bedside nurses and respiratory therapists are the primary educators. They often lack the time or knowledge to provide high level asthma education. High risk asthmatic patients and their caregivers may benefit from comprehensive face-to-face education and assessment of barriers from a certified asthma educator.
Methods: An Inpatient Asthma Education Consult (IAEC) service was created with team of certified asthma educators. Consults were requested by pulmonary consult and inpatient care teams on patients with a new or existing diagnosis of asthma who were admitted to PICU, had ≥2 hospitalizations or ED/UC visits the previous 12 months, and/or concerns for poor medication adherence. The IAEC included 30+minutes of face-to-face education with the patient and caregiver(s) reviewing what is asthma, asthma triggers, asthma medications, and review of the individualized asthma action plan. During the face-to-face education barriers to adherence and provider follow up were also addressed with resources provided based on the identified barrier. The IAEC also help facilitate follow up or referral for a follow up visit with a specialist (Pulmonary or Allergy) after discharge.
Results: The IAEC service completed 55 consults from October 2018 to April 2019. Prior to the IAEC, 100% (95% CI: 93% to 100%) of 55 patients had at least one hospital and/or ED/UC visit the previous year. After the intervention, 38% (95% CI: 27% to 51%) of 55 patients revisited the hospital. McNemar’s test indicated a statistically significant difference in the paired proportions before and after intervention (S=21, df = 1, P<.001).
Conclusions: Providing comprehensive, one on one face-to-face asthma education and working with patients and their caregiver(s) to address barriers to medication adherence and follow up post discharge from the hospital can improve patient outcomes.
Patient Demographics
Patient Outcomes
Footnotes
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