ABSTRACT
Introduction Imagine that you are at a large children’s hospital with well-trained staff who treat more than eight hundred admissions for acute asthma each year but that your hospital does not have a standard approach to the management of asthma. Thus, two patients with acute asthma of similar severity might receive completely different doses, frequencies, and methods of administering medications. For example, one patient with acute asthma could receive 10 mg of albuterol (a bronchodilator medication used to ease breathing) every two hours and remain on this dose and frequency overnight despite clinical improvement because the pediatric resident on call does not have time to reevaluate the patient. Another patient who is receiving 2.5 mg of albuterol every four hours deteriorates but does not have his therapy escalated for similar reasons. There is no standard approach that specifies how to
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assess the need for and response to bronchodilators, and nurses and respiratory therapists (RTs) are relegated to simply administering the ordered medications. This leads to unwarranted variation in resource consumption and increased hospital length of stay (LOS), with significant cost implications. Thus, two patients with similar asthma exacerbations can have significantly different hospital LOSs, and, conversely, patients with different levels of severity might end up spending the same amount of time in the hospital. Before implementing changes in asthma care using continuous performance improvement (CPI), the length of stay for asthma at our institution was approximately two days (see Table 11.1), which was similar to the national average LOS amongst pediatric tertiary care hospitals. However, by implementing changes through CPI, we standardized our asthma care, which decreased hospital LOS, empowered nurses and RTs by allowing them input into the medication-weaning process, and decreased physician workload.
