TOP 55 - From Admission to Discharge: Optimization of the Asthma Care Continuum

Publication Number: 2807.TOP 55

Emily M. Kraft, Jacobi Medical Center, New York, NY, United States; Jonathan Derryberry, Jacobi Medical Center, Bronx, NY, United States; Nereyda Ochoa-Jacob, Albert Einstein College of Medicine, New York, NY, United States; Emily Goodloe, Albert Einstein College of Medicine, New york, NY, United States; Samm Lehmann, NYC Health + Hospitals/Jacobi, New York, NY, United States; Asher G. Bercow, Jacobi Medical center, Bronx, NY, United States; Noe D. Romo, Albert Einstein College of Medicine, Bronx, NY, United States; Raidour Ahmed, Jacobi Medical Center, Bronx, NY, United States

Background: Pediatric inpatient services experience seasonal variations in respiratory related admissions, with an expected winter increase in asthma, bronchiolitis, and other viral upper respiratory tract infection related admissions. The seasonally dependent increase in pediatric inpatient volume often occurs in a setting of already existing staff shortages that contributes to a national hospital boarding crises, resulting in sub-optimal transitions of patient care. Consequently, there are often delayed discharges from the pediatric floor resulting in delayed admissions from the ER. At NYC Health+Hospitals/Jacobi, a public hospital in the Bronx NY, we have seen how asthma-related health disparities directly result in children admitted with asthma missing multiple school days, especially during the winter months. The delays in discharge contributing to inpatient care workflow disruptions and prolonged length of stay (LOS), are the result of unaddressed multifactorial issues, highlighting a need to optimize the asthma discharge process.

Objective: An early discharge allows for smoother workflow in pediatric floors and emergency rooms and allows families to make appropriate arrangements for transportation and childcare. Our primary SMART Aim was to increase the proportion of patients with asthma discharged before noon from our pediatric inpatient service by 20% from baseline by January 1, 2026.

Design/Methods: Monthly EMR data was collected (Figure 1): medication administration record (MAR) of inhaled asthma treatments Q4 (every four hours), discharge order placement, and discharge completion. Data analysis calculated our process and outcome measures (Figure 2 & 3). Our primary interventions were divided into two PDSA cycles in January and September 2025. The first PDSA cycle addressed spacing our asthma patients at 2am instead of 6am using PRS asthma scoring. In response to our data, we started our second PDSA cycle focusing on stream-lining our discharge through the use of the EPIC EMR dotphrases. These interventions are reflected in our process measure, the percentage of patients with a discharge order placed prior to 12pm. The outcome measure was the percentage of patients with completed discharge prior to 12pm. Our balancing measures included readmissions within 7 days, average LOS, and transfer to a higher level of care (PICU).

Asthma Admission Flowchart
Fig. 1 Reflects the systematic process of an admission for an asthma patient from the time of admission to discharge completion. Identifies critical points in the throughout the admission every 4 hours treatments, discharge order, and order placement. Highlights at what point of the admission our PDSA interventions were addressing.

Yearly Percentage of Discharge Orders and Completed Discharges Achieved Before Noon
Fig 2. Column chart showing the change in the percentages of discharge orders being placed before and discharges being completed before noon between 2024 and 2025 to show impact of measures from PDSA 1 (implemented in January 2025). The data shows a relative increase in discharge orders being placed before noon of 23.33%, as well as an increase of 88.96% of discharges completed before noon.

p-Chart for Discharge Completion
Fig 3. p-Chart based on failures for monthly data sets regarding discharge order completion (failure being discharge completed after noon). Dotted lines mark the implementation of PDSA 1 (green) and PDSA 2 (red) in January and September of 2025, respectively. Of 22 sets, two monthly failure rates sat outside the control limits.