576 - Reducing Length of Stay Without Increasing Adverse Events, Revisits or Readmissions: A Systematic Review to Evaluate the Safety and Efficacy of Inpatient Beta-Agonist Weaning Protocols

Publication Number: 2561.576

Susan L. Flesher, Marshall University Joan C. Edwards School of Medicine, Huntington, WV, United States; Ayesha Liaqat, Marshall University Joan C. Edwards School of Medicine, New Orleans, LA, United States; Steven K. Skaggs, Norton Children’s Medical Group - Frankfort, Versailles, KY, United States; Marie Frazier, Marshall University, Huntington, WV, United States; Chris Gillette, Wake Forest University School of Medicine, Clemmons, NC, United States; Nicole Rockich-Winston, Medical College of Georgia at Augusta University, Augusta, GA, United States

Background: Inpatient care for pediatric asthma incurs substantial costs and lost school days. Beta-agonist agonist weaning processes impact length of stay (LOS) and safety. Weaning practices and discharge criteria vary widely, and multiple, often unvalidated, scoring systems are used to guide decisions.

Objective: To evaluate the safety and efficacy of inpatient albuterol/salbutamol weaning protocols, including pathway type and use of clinical scoring systems, for reducing LOS without increasing adverse events, revisits, or readmissions.

Design/Methods: We followed PRISMA guidelines and registered in PROSPERO (CRD42022291072). Databases searched: PubMed/MEDLINE, EMBASE, CINAHL, and Web of Science. Inclusion criteria: patients aged 2–17 years admitted primarily for asthma; explicit description of weaning protocol; algorithm for discharge readiness; LOS reported. Reviewers independently screened, extracted data, and assessed reporting quality using SQUIRE; discrepancies were resolved by consensus. We identified 11,512 records; removed 2,475 duplicates, 9,037 abstracts were screened, 73 full texts were assessed, and 9 studies met inclusion.

Results: Using protocols consistently improved outcomes. Respiratory therapist-driven pathways reduced overall hospital LOS, PICU LOS, and duration of continuous albuterol, without increases in revisits or readmissions. Nurse-driven pathways reduced time on continuous albuterol and, in some studies, also reduced LOS. Clinical pathways, including PICU and community hospital implementations, were associated with decreased LOS, beta-agonist use, PICU LOS, duration on continuous albuterol, and time to clinical recovery, with no increase in adverse events, revisits, or readmissions. One study showed reduced cost and enhanced care, including higher rates of asthma education and discharge with controller therapy, peak flow meter, and spacer. A study permitting discharge at q3h albuterol safely shortened LOS, though it did not use a clinical asthma score. Most studies used a clinical asthma score; but eight different systems were employed and only one was validated.

Conclusion(s): Protocol-driven weaning reduces LOS and cost while maintaining safety and may enhance quality. Allowing discharge at q3h may safely shorten LOS but requires confirmation using validated scoring and prospective evaluation. Future research should prioritize standardization, particularly adoption of validated tools to allow comparability and strengthen evidence for optimal weaning and discharge criteria.