A Report of an Asthma Pathway Leading to Improved Resource Use

OBJECTIVES: Asthma pathways have been shown to improve resource use and decrease length of stay (LOS). A tertiary care hospital implemented an asthma pathway in May 2015 to standardize inpatient care. We predicted that the pathway would increase the use of albuterol metered-dose inhalers (MDIs) and steroids; decrease use of albuterol nebulizer, antibiotics, chest radiograph (CXR), and respiratory viral panel (RVP); and decrease LOS.

METHODS: This retrospective cohort study selected patients between the ages of 2 and 18 years who were admitted for asthma as a primary diagnosis between May 2014 and May 2016 (1 year preimplementation to 1 year postimplementation). Patients' complex chronic conditions were excluded. We analyzed use of albuterol nebulizer, MDI, and continuous nebulization, ipratropium bromide, oral steroids, antibiotics, inhaled steroids, CXR, and RVP. We also evaluated LOS and readmission rate.

RESULTS: There were 1131 and 925 patients identified before and after asthma pathway implementation, respectively. The percent that received albuterol nebulizer decreased from 14.1% to 6.1% (p < 0.001). The percent that received albuterol MDI increased from 97.0% to 99.4% (p < 0.001). The average number of MDI administrations decreased from 11.6 to 10.4 (p = 0.004). Continuous albuterol use increased from 52.3% to 59.1% (p = 0.002). There was no change in ipratropium bromide, oral steroid, inhaled steroid, or CXR use. Antibiotic (p = 0.049) and RVP (p = 0.03) use decreased. The average LOS decreased from 1.84 days to 1.71 days (p = 0.02). Readmission rates did not change significantly.

CONCLUSIONS: The asthma pathway improved inpatient albuterol MDI use. The LOS decreased while maintaining readmission rates.