TOP 41 - Improving Pediatric Asthma Management in Community Emergency Departments

Publication Number: 4744.TOP 41

Camille Audette, UMass Memorial Children's Medical Center, Whitinsville, MA, United States; Bonnie Mathews, UMass Memorial Children's Medical Center, Worcester, MA, United States; Falgun Wylie, University of Massachusetts Medical School, Worcester, MA, United States

Background: Acute asthma exacerbation is one of the most common presentations of pediatric patients to the emergency department. There exists a wide variety in how these patients are treated in the community, especially at hospitals without pediatric emergency medicine (PEM) trained physicians, despite evidence based guidelines on the use of early and multiple albuterol-ipratropium nebulizers (DuoNeb) for moderate asthma exacerbations. Under-treatment of wheezing leads to unnecessary transfers, prolonged length of stay, decreased patient satisfaction, and potential increased patient morbidity and mortality.

Objective: To increase the number of patients who receive 3 back-to-back DuoNebs (stacked DuoNebs) for initial management of moderate to severe asthma exacerbations and ultimately to reduce the number of patients transferred to higher levels of care.

Design/Methods: We conducted a single-site quality improvement project in the Emergency Department of a community hospital in central Massachusetts. We utilized LEAN methodology, a systemic approach to quality improvement focusing on eliminating waste and adding value. A multi-disciplinary team was assembled, including PEM physicians, emergency medicine providers, nurses, pharmacists, and respiratory therapists from both the community hospital and the academic center. A process map and root cause analysis were completed, and countermeasures were identified. Multiple "Plan, Do, Study, Act (PDSA)" cycles were completed and changes implemented, including education aimed at nursing, respiratory therapy, and clinical providers regarding appropriate asthma management in pediatric patients and the utilization of a pediatric emergency department asthma order set to standardize care and encourage use of standard treatment provided in the pediatric emergency department. Patients were identified using diagnosis code, and anonymized data was collected on number and type of treatments given, whether the order set was utilized, and whether the patient was transferred to a higher level of care, as well as the ultimate disposition of the patient. Primary outcome measures will be the number of patients appropriately receiving stacked DuoNebs and number of patients transferred to a higher level of care. Data will be analyzed and charted on a run chart to show how outcomes changed over time and with education interventions. Data to be analyzed by January 2026.