539 - Increasing Utilization of Pediatric Asthma Scores in a Pediatric Emergency Department to Improve Time to Albuterol and Steroids

Publication Number: 2524.539

Jamie L.. Smith, Children's Mercy Hospitals and Clinics, Overland Park, KS, United States; Tyler Keene, Children’s mercy hospital, Liberty, MO, United States; Chris Kaberline, Children's Mercy Hospitals and Clinics, Prairie Village, KS, United States; Leslie A. Hueschen, University of Missouri-Kansas City School of Medicine, Kansas City, MO, United States

Background: The pediatric asthma score (PAS) is a validated scoring tool used in the emergency department (ED) setting that assesses asthma severity, guides timely treatment1 and has been shown to improve patient outcomes2.  Initially, only 5% of eligible patients had a PAS performed at Children’s Mercy Hospital Kansas ED (CMK ED).

Objective: By December 2025, we aim to increase utilization of the PAS from 5% to 50% at the CMK ED. A secondary aim is to reduce the time to treatment administration (steroids and albuterol) for asthmatic patients by 10%.

Design/Methods: A multidisciplinary team was formed with RT, QI consultants, ED physicians, and nurses. CMK ED patients were eligible if they were > 2 years old with a history of asthma and chief complaints include breathing. A fishbone diagram helped identify interventions which were implemented with a plan-do-study-act methodology (Table 1).  Outcome measures included the time from ED room arrival to albuterol and steroid administered.  Process measures include the percentage of patients with a PAS score and the percentage of RT trained to perform a PAS score. ED length of stay was used as a balance measure. Data was collected monthly, and statistical methodology was used to determine centerline shifts.

Results: CMK ED averaged 105 eligible patients a month. There was an increase in RTs trained in PAS utilization from 0% to 60% by May 2025 and 100% by October 2025. PAS utilization on eligible patients improved with two centerline shifts, from 5% to 30% (April 2025) (Fig 1). In March 2025 we noted atrend for improvement in time to albuterol administration but there was no statistical improvement in time to steroid administration or length of stay (Fig 2).

Conclusion(s): Although we did not reach our target of 50% PAS utilization, we achieved a meaningful increase to 30%, with a peak of 48% in September. This improvement was correlated with faster administration of albuterol, though time to steroid administration and length of stay remained unchanged.  The most impactful intervention was face-to-face engagement with staff, which enhanced transparency and reinforced their role in driving measurable change. Key limitations included the inability to utilize the EMR to identify PAS-eligible patients. Additionally, provider quick evaluation of high-acuity patients (Emergency Severity Index [ESI] levels 1 and 2) also limits intervention prior to provider evaluation. Looking ahead, we plan to stratify data by lower-acuity patients (ESI levels 3–5). Identifying gaps in this group will guide future interventions.

Table 1: PDSA Interventions
Image 10-31-25 at 1.09 PM.jpeg

Figure 1: Percentage of eligible patients with PAS score done (SPC) 
Image 10-31-25 at 1.09 PM (1).jpeg

Figure 2: Time to albuterol from rooming (SPC)
Image 10-31-25 at 1.10 PM.jpeg