Improving Pediatric Asthma Care in a Community Emergency Department

From the NEJM:

The paradox of pediatric emergency care is that while most children are seen in general emergency departments (EDs) by general emergency physicians, only a small fraction of the patients seen by most general emergency physicians are children. Improved adherence to evidence-based guidelines has been shown to improve outcomes, and this is certainly true in children with asthma, but quality improvement efforts have not been tested in general community EDs.

Aiming to improve pediatric asthma care and decrease transfers, a general community ED collaborated with a nearby pediatric ED that had implemented an evidence-based clinical pathway for asthma. The general community ED implemented a quality improvement process that included the clinical pathway as well as stakeholder engagement, assessment of ED work processes, and increased availability of dexamethasone and respiratory therapists. Available in paper and electronic formats, the pathway included an asthma severity score and sample orders for providers and triage nurses.

After pathway implementation, compared with before, steroids were administered during the ED visit significantly more often (76% vs. 60% of patients) and sooner (105 vs. 196 minutes). The rate of interhospital transfer dropped significantly from 14% before implementation to 10% after, without an increase in return visits.

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