Breathing Easier: Discharging Hospitalized Asthma Patients on q3h Saba Treatments
Purpose/Objectives: In 2004, almost 200,000 children were hospitalized due to asthma in the United States, costing nearly $280 million.1-2 Rising health care costs have led to initiatives to improve discharge timeliness without compromising patient safety or increasing readmission rates. Typically, hospitalized asthma patients are considered medically ready for discharge when their short acting beta agonist (SABA) treatments are spaced to every four hours (Q4H) or longer. Though this was not specified in the 2007 NHLBI ASTHMA guidelines, it is common practice according to guidelines obtained from multiple children’s hospitals nationwide. The goal of our study is to shorten length of stay by discharging asthmatics when they reach every 3 hour SABA frequency, while not leading to an increase in readmissions. Design/Methods: In 2013, discharge criteria for asthma exacerbations was changed from Q4H to Q3H SABA treatments; additional discharge criteria such as improving clinical respiratory score and lack of oxygen requirement remained unchanged. Interventions included physician, nursing, and respiratory therapist education, as well as changing the Respiratory Assessment and Management Protocol, an established SABA weaning protocol at our institution. Additionally, electronic medical record changes were made to the asthma order set and note templates to remind providers of this change in discharge criteria. The main outcome measures were readmission rate, to ensure that earlier discharge did not lead to increased readmissions, and length of stay. Statistical analysis was performed using statistical process control charts and Mann-Whitney test. Results: Initial data from 2013 after the change in discharge criteria revealed a trend toward decreased length of stay, although this was not statistically significant. There was no increase in readmission rates during this period. Additional chart review, data analysis and validation are 2ongoing, and will be complete prior to July 2016. Conclusion/Discussion: Based on preliminary data, it appears that changing discharge criteria to every 3 hour SABA treatments may lead to decreased length of stay without increasing readmission rates. By safely discharging asthmatics who are clinically improving from the hospital sooner, we are able to improve hospital throughput and bedspace utilization.
Run chart: 14 day readmission rate
Run chart: Length of stay
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