Application of Standardization of Care in Pediatric Asthma Management

Patient Safety and Quality

Christine Andrusiw
Director, Performance Improvement
Cooper University Hospital

Vatsala Ramprasad
MD, Chair, Department of Pediatric Pulmonary Medicine
Cooper University Hospital

Sally Hinkle
Performance Improvement Coordinator
Cooper University Hospital

The key learning points of this presentation are application of performance improvement strategies to improve outcomes and development of clinical tools to implement standardizing of pediatric asthma treatment and education in the urban setting. Challenges of information management and analysis using risk severity adjustment are addressed.

Problem Identification and baseline data:
Asthma is one of the most common chronic conditions in the United States and is cited as the most frequent reason for preventable hospital admissions among children. The Asthma and Allergy Foundation of America estimates that there are 142,000 children with asthma in New Jersey and the prevalence of asthma admissions is greatest in urban settings. According to the CDC, from 1994 through 2000 there were 30,400 asthma hospitalizations in New Jersey with 22.9% of all admissions experiencing multiple readmissions. Readmission rates are arguably driven by issues of disease management with the need for standardization of asthma management and education.

Methods and Timeline:
1.Establishment of an interdisciplinary asthma work group that includes medical, nursing and ancillary staff representation from the departments of: pediatric pulmonary medicine, pediatric critical care, pediatric emergency medicine, general pediatrics, respiratory therapy, and pharmacy.

2.Retrieval & analysis of pediatric asthma outcomes data for Emergency Room visits and hospital admissions.

3.Development and implementation of Pediatric Emergency Department Asthma/Status Asthmatics Interdisciplinary clinical pathway.

4.Evaluation of provider utilization of Emergency Room clinical pathway.

5.Development of Status Asthmatics inpatient interdisciplinary clinical pathway.

6.Standardization of CPOE pediatric asthma order sets.

7.Development of an educational brochure.

8.Development of educational outreach through partnerships with community based health centers. Involves communication of children's outpatient progress.

9.Standardization of pulmonary score for consistent assessment and treatment.

1. A 1.0% reduction in transfers from floor to ICU level of care.
2. A 2.4% reduction in 30 day readmission rates.
3. A 49% reduction in admissions from the ED while # ED visits increased 1%.