Increasing Treatment with Metered Dose Inhaler to Improve Efficiency of Care for Children with Mild-Moderate Asthma in the Emergency Department

Zorc, Joseph J.; Abaya, Ruth; Delgado, Eva; Reardon, Ann Marie; Rodio, Bonnie; Simpkins, Denise; Moxey, Elizabeth D.; Nayar, Vaidehi; Scarfone, Richard J.

doi:10.1542/peds.140.1_meetingabstract.12

Cited by 1 publication

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“…To adhere to best practices, we integrated modified CXR indication criteria adapted from established pediatric asthma guidelines and pathways. 3,5,10 Our findings align with previous research conducted in community hospitals, which examined the effectiveness of pediatric asthma pathways. Pediatric asthma pathways typically include instructions for assessing a child’s clinical severity and offering treatment recommendations, yielding several benefits for children with asthma in the ED and inpatient settings.…”

Section: Discussionmentioning

confidence: 99%

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A Quality Improvement Initiative to Minimize Unnecessary Chest X-Ray Utilization in Pediatric Asthma Exacerbations

Sakr,

Al Kanjo,

Balasundaram

et al. 2024

Pediatric Quality &Amp; Safety

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Background: Current national guidelines recommend against chest X-rays (CXRs) for patients with acute asthma exacerbation (AAE). The overuse of CXRs in AAE has become a concern, prompting the need for a quality improvement (QI) project to decrease CXR usage through guideline-based interventions. We aimed to reduce the percentage of CXRs not adhering to national guidelines obtained for pediatric patients presenting to the Emergency Department (ED) with AAE by 50% within 12 months of project initiation. Methods: We conducted this study at a New York City urban level-2 trauma center. The team was composed of members from the ED and pediatric departments. Electronic medical records of children aged 2 to 18 years presenting with AAE were evaluated. Monthly data on CXR utilization encompassing instances where the ordered CXR did not adhere to guidelines was collected before and after implementing interventions. The interventions included provider education, visual reminders, printed cards, grand-round presentations, and electronic medical records modifications. Results: The study encompassed 887 eligible patients with isolated AAE. Baseline data revealed a mean preintervention CXR noncompliance rate of 37.5% among children presenting to the ED with AAE. The interventions resulted in a notable decrease in unnecessary CXR utilization, reaching 16.7%, a reduction sustained throughout subsequent months. Conclusions: This QI project successfully reduced unnecessary CXR utilization in pediatric AAE. A multi-faceted approach involving education, visual aids, and electronic reminders aligned clinical practice with evidence-based guidelines. This QI initiative is a potential template for other healthcare institutions seeking to curtail unnecessary CXR usage in pediatric AAE.

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Section: Discussionmentioning

confidence: 99%

“…A comparison was made between these guidelines and widely recognized resources to determine CXR indications during an asthma exacerbation. 3 , 5 , 10 , 11 The interventions were executed over 5 monthly cycles, using the Plan-Do-Study-Act (QI methodology. The series of interventions included:…”

Section: Interventionsmentioning

confidence: 99%