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Research ArticleOriginal Research

An Asthma Protocol Improved Adherence to Evidence-Based Guidelines for Pediatric Subjects With Status Asthmaticus in the Emergency Department

Andrew G Miller, Moira E Breslin, Leslie C Pineda and James W Fox
Respiratory Care December 2015, 60 (12) 1759-1764; DOI: https://doi.org/10.4187/respcare.04011
Andrew G Miller
Department of Respiratory Care Services
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  • For correspondence: [email protected]
Moira E Breslin
Department of Pediatrics, University of California at Los Angeles, Los Angeles, California.
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Leslie C Pineda
Department of Pediatrics, Duke University Medical Center, Durham, North Carolina.
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James W Fox
Department of Pediatrics, Duke University Medical Center, Durham, North Carolina.
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Abstract

BACKGROUND: In our institution's pediatric emergency department, adherence to evidence-based asthma guidelines was noted to be suboptimal for patients with asthma exacerbations. We hypothesized that an evidence-based asthma protocol would improve time to treatment and adherence to National Institutes of Health guidelines for patients presenting to the emergency department with status asthmaticus.

METHODS: Subjects at our institution were retrospectively identified through an electronic medical record search following institutional review board approval. The asthma protocol was initiated in February 2012. All pediatric subjects who received continuous albuterol in the emergency department before (February 26, 2009, to February 22, 2012, n = 193) and after (February 23, 2012, to December 31, 2012, n = 68) protocol initiation were analyzed. The post-protocol data were collected as part of routine quality assurance monitoring with a target of 60 post-protocol subjects. Subjects were identified at the end of each month, which resulted in a total of 68 subjects being included. Primary outcomes measured included time to initial treatment with inhaled bronchodilator therapy, time to treatment with systemic corticosteroids, and total number of ipratropium bromide treatments delivered.

RESULTS: Two-hundred sixty-one subjects (7.1 ± 4.6 y of age, 66% male) were included. Demographics were similar in the pre- and post-protocol groups. Compared with the pre-protocol group, more subjects in the post-protocol group received bronchodilators within 30 min (60% vs 77%, P = .02), at least one dose of ipratropium bromide (55% vs 87%, P < .001), 3 doses of ipratropium bromide (14% vs 54%, P < .001), and corticosteroids within 60 min (62% vs 77%, P = .04). There were no statistically significant differences between the pre- and post-protocol cohorts in the mean time to first bronchodilator treatment (32 ± 41 vs 26 ± 52 min, P = .34), mean time to corticosteroid administration (74 ± 68 vs 54 ± 63 min, P = .06), or mean emergency department length of stay (342 ± 143 vs 364 ± 183 min, P = .31).

CONCLUSIONS: An asthma protocol resulted in improved adherence to National Institutes of Health guidelines in children with status asthmaticus and improved efficiency in the administration of rescue bronchodilator and systemic corticosteroid therapy.

  • pediatric asthma
  • asthma
  • status asthmaticus
  • asthma protocol
  • protocol-based care
  • severe asthma
  • continuous bronchodilator
  • emergency department

Footnotes

  • Correspondence: Andrew G Miller RRT-ACCS, Respiratory Care Services, Duke University Medical Center, PO Box 3911, 2301 Erwin Road, Durham. NC 27710. E-mail: andrew.g.miller{at}duke.edu.
  • This study was supported by departmental funding. The authors have disclosed no conflicts of interest.

  • Copyright © 2015 by Daedalus Enterprises
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Respiratory Care: 60 (12)
Respiratory Care
Vol. 60, Issue 12
1 Dec 2015
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An Asthma Protocol Improved Adherence to Evidence-Based Guidelines for Pediatric Subjects With Status Asthmaticus in the Emergency Department
Andrew G Miller, Moira E Breslin, Leslie C Pineda, James W Fox
Respiratory Care Dec 2015, 60 (12) 1759-1764; DOI: 10.4187/respcare.04011

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An Asthma Protocol Improved Adherence to Evidence-Based Guidelines for Pediatric Subjects With Status Asthmaticus in the Emergency Department
Andrew G Miller, Moira E Breslin, Leslie C Pineda, James W Fox
Respiratory Care Dec 2015, 60 (12) 1759-1764; DOI: 10.4187/respcare.04011
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Keywords

  • pediatric asthma
  • Asthma
  • status asthmaticus
  • asthma protocol
  • protocol-based care
  • severe asthma
  • continuous bronchodilator
  • Emergency Department

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