Triage Nurse Initiation of Corticosteroids in Pediatric Asthma Is Associated With Improved Emergency Department Efficiency

Zemek, Roger; Plint, Amy C.; Osmond, Martin H.; Kovesi, Tom; Correll, Rhonda; Perri, Nicholas; Barrowman, Nicholas J.

doi:10.1542/peds.2011-2347

Cited by 74 publications

(74 citation statements)

References 26 publications

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“…This finding suggests that the rate of exposure to triggers, experiencing disease symptoms, and using medications for these reasons decreased because of the asthma management program used in this study. Other studies also indicated that bronchodilators and corticosteroids are frequently used [12,20].…”

Section: Discussionmentioning

confidence: 99%

Effects of an Asthma Training and Monitoring Program on Children's Disease Management and Quality of Life

Ekici¹,

Cimete²

2015

Turk Thorac J

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OBJECTIVES:To determine the effects of an asthma training and monitoring program on children's disease management and quality of life. MATERIAL AND METHODS:The sample consisted of 120 children and their parents. Data were collected during, at the beginning, and at the end of the 3-month monitoring period using four forms and a quality of life scale. After an initial evaluation, approaches to control symptoms and asthma triggers and measures that might be taken for them were taught to the children and parents. The children recorded the conditions of trigger exposure, experience of disease symptoms, their effects on daily activities, and therapeutic implementations on a daily basis. RESULTS:During the 3-month monitoring period, the number of days when the children were exposed to triggers (p=0.000) and experienced disease symptoms decreased to a statistically significant level (p=0.006). Majority of domestic triggers disappeared, but those stemming from the structure of the house and non-domestic triggers indicated no change (p>0.05). Moreover, 30.8% of the children applied to a physician/hospital/emergency service, 4.2% of the children were hospitalized, and 30% of them could not go to school. The number of times when the children applied to a physician/hospital/emergency (p=0.013), the number of times they used medicines (p=0.050), and the number of days they could not go to school (p=0.002) decreased at a statistically significant level, and their quality of life increased (p=0.001). CONCLUSION:Asthma training and monitoring program decreased children's rate of experiencing asthma symptoms and implementations of therapeutic purposes and increased their life quality.

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Section: Discussionmentioning

confidence: 99%

Effects of an Asthma Training and Monitoring Program on Children's Disease Management and Quality of Life

Ekici¹,

Cimete²

2015

Turk Thorac J

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“…[7–12] In the original randomized controlled trials of efficacy, corticosteroids were administered within one hour of ED arrival. [6, 7] Several recent studies have confirmed that timely corticosteroid administration is associated with reduced odds of admission [13–15] and that every 30-minute delay in corticosteroid administration is associated with a nearly 20% increased odds of admission. [14] Consequently, the proportion of children receiving timely corticosteroids is a measure of ED quality of care.…”

Section: Introductionmentioning

confidence: 99%

“…[11, 17, 19–23] In addition, frequent delays in corticosteroid administration (52–78% of visits) have been reported. [13–15, 21, 22] Studies from Canada, United Kingdom, South America, and Australia have demonstrated the value of ED clinical pathways in the management of pediatric asthma exacerbations. Pathways have been associated with increased frequency of appropriate corticosteroid administration, [15, 24] expedited corticosteroid administration, [13, 15] and decreased hospitalization rates, [13, 15, 25] ED LOS, [13, 26] prescribing errors [24] and return visits.…”

Section: Introductionmentioning

confidence: 99%

Clinical pathway improves pediatrics asthma management in the emergency department and reduces admissions

Bekmezian¹,

Fee

Weber

2015

Journal of Asthma

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Objective Poor adherence to NIH Asthma Guidelines may result in unnecessary admissions for children presenting to the emergency department (ED) with exacerbations. We determine the effect of implementing an evidence-based ED clinical pathway on corticosteroid and bronchodilator administration and imaging utilization, and the subsequent effect on hospital admissions in a US ED. Methods Prospective, interventional study of pediatric (≤21 years) visits to an academic ED between 2011 and 2013 with moderate-severe asthma exacerbations. A multidisciplinary team designed a one-page clinical pathway based on NIH guidelines. Nurses, respiratory therapists, and physicians attended educational sessions prior to pathway implementation. Adjusting for demographics, acuity, and ED volume, we compared timing and appropriateness of corticosteroid and bronchodilator administration, and chest radiograph (CXR) utilization with historical controls from 2006–2011. Subsequent hospital admission rates were also compared. Results 379 post-intervention visits were compared with 870 controls. Corticosteroids were more likely to be administered during post-intervention visits (96% vs. 78%, adjusted OR 6.35; 95%CI 3.17–12.73). Post-intervention, median time to corticosteroid administration was 45 minutes faster (RR 0.74; 95%CI 0.67–0.81) and more patients received corticosteroids within 1 hour of arrival (45% vs 18%, OR 3.5; 95%CI 2.50–4.90). More patients received >1 bronchodilator dose within 1 hour (36% vs 24%, OR 1.65; 95%CI 1.23–2.21) and fewer received CXRs (27% vs 42%, OR 0.7; 95%CI 0.52–0.94). There were fewer admissions post-intervention (13% vs. 21%, OR 0.53; 95%CI 0.37–0.76). Conclusion A clinical pathway is associated with improved adherence to NIH guidelines and, subsequently, fewer hospital admissions for pediatric ED patients with asthma exacerbations.

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“…This protocol was based on the 2007 NIH guidelines and designed to be nurseinitiated, as triage nurse-driven protocols have been shown to reduce hospital admissions, time to corticosteroid administration, time to patient improvement, and time spent by patients in the emergency department. [4][5][6] The effect of a nurse-driven protocol in the emergency department setting on patients with status asthmaticus has not been studied. The objective of this study was to examine the effects on time to initial treatment and adherence to evidencebased practice for status asthmaticus after the implementation of an evidence-based, nurse-initiated pediatric asthma protocol in our pediatric emergency department.…”

Section: Introductionmentioning

confidence: 99%

An Asthma Protocol Improved Adherence to Evidence-Based Guidelines for Pediatric Subjects With Status Asthmaticus in the Emergency Department

Miller¹,

Breslin

Pineda

et al. 2015

Respir Care

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BACKGROUND: In our institution's pediatric emergency department, adherence to evidencebased asthma guidelines was noted to be suboptimal for patients with asthma exacerbations. We hypothesized that an evidence-based asthma protocol would improve time to treatment and adherence to National Institutes of Health guidelines for patients presenting to the emergency department with status asthmaticus. METHODS: Subjects at our institution were retrospectively identified through an electronic medical record search following institutional review board approval. The asthma protocol was initiated in February 2012. All pediatric subjects who received continuous albuterol in the emergency department before (February 26, 2009, to February 22, 2012, n ‫؍‬ 193) and after (February 23, 2012, to December 31, 2012, n ‫؍‬ 68) protocol initiation were analyzed. The post-protocol data were collected as part of routine quality assurance monitoring with a target of 60 post-protocol subjects. Subjects were identified at the end of each month, which resulted in a total of 68 subjects being included. Primary outcomes measured included time to initial treatment with inhaled bronchodilator therapy, time to treatment with systemic corticosteroids, and total number of ipratropium bromide treatments delivered. RESULTS: Two-hundred sixty-one subjects (7.1 ؎ 4.6 y of age, 66% male) were included. Demographics were similar in the pre-and postprotocol groups. Compared with the pre-protocol group, more subjects in the post-protocol group received bronchodilators within 30 min (60% vs 77%, P ‫؍‬ .02), at least one dose of ipratropium bromide (55% vs 87%, P < .001), 3 doses of ipratropium bromide (14% vs 54%, P < .001), and corticosteroids within 60 min (62% vs 77%, P ‫؍‬ .04). There were no statistically significant differences between the pre-and post-protocol cohorts in the mean time to first bronchodilator treatment (32 ؎ 41 vs 26 ؎ 52 min, P ‫؍‬ .34), mean time to corticosteroid administration (74 ؎ 68 vs 54 ؎ 63 min, P ‫؍‬ .06), or mean emergency department length of stay (342 ؎ 143 vs 364 ؎ 183 min, P ‫؍‬ .31). CONCLUSIONS: An asthma protocol resulted in improved adherence to National Institutes of Health guidelines in children with status asthmaticus and improved efficiency in the administration of rescue bronchodilator and systemic corticosteroid therapy.

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Triage Nurse Initiation of Corticosteroids in Pediatric Asthma Is Associated With Improved Emergency Department Efficiency

Abstract: Triage nurse initiation of oral corticosteroid before physician assessment was associated with reduced times to clinical improvement and discharge, and reduced admission rates in children presenting with moderate to severe acute asthma exacerbations.

Cited by 74 publications

References 26 publications

Effects of an Asthma Training and Monitoring Program on Children's Disease Management and Quality of Life

Effects of an Asthma Training and Monitoring Program on Children's Disease Management and Quality of Life

Clinical pathway improves pediatrics asthma management in the emergency department and reduces admissions

An Asthma Protocol Improved Adherence to Evidence-Based Guidelines for Pediatric Subjects With Status Asthmaticus in the Emergency Department

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