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Children’s of Alabama marked an important milestone with the celebration of the Asthma Clinical Pathway’s 10-Year Anniversary. The quality improvement initiative began in March 2011 with an aim to reduce inpatient asthma length of stay through the delivery of evidence-based, acute asthma care.
Pediatric asthma is a common chronic disease and a leading cause of pediatric hospitalization. Dr. Terri Magruder, director of the Pulmonary Asthma Program and the physician champion for the initiative stated, “At the time we were starting this improvement process, there were several hundred asthma admissions annually, inpatient asthma length of stay and hospital charges were increasing.”
The Asthma Clinical Pathway was developed through the efforts of an interdisciplinary team consisting of physicians from the University of Alabama at Birmingham’s (UAB) Division of Pediatric Pulmonary and Sleep Medicine, Division of Pediatric Hospital Medicine, Division of Academic General Pediatrics and Division of Pediatric Emergency Medicine. In addition, multiple Children’s departments contributed to the development of the initiative, including Respiratory Therapy, Pharmacy, Nursing Services, Patient Placement, Health and Safety Information and the Pediatric Simulation Center.
The pathway has helped improve inpatient asthma care from admission to discharge with its standardized care process and discharge criteria. Within the first two years of implementation, Children’s met the national benchmark for reducing hospital stays to less than two days. “We are pleased we have been very successful in sustaining our improvement efforts,” said Dr. Magruder.
Prior to its development, inpatient care involved a direct, hands-on physician approach without consistent treatment protocols or evidence-based data. Now, physicians are able to place a patient on the pathway, allowing respiratory therapists to administer the proven standard of care.
“The Asthma Clinical Pathway enables us to utilize respiratory therapy resources more efficiently,” said Robert Park, administrative director of Respiratory Care. “We are able to assess, treat and adjust patient therapy as needed following the pathway guidelines,” he continued. “The provider is always available if there are any concerns or if there is a need to remove a patient from the pathway. Evaluation of the data we collect allows us to identify opportunities for improvement and implement changes that enhance outcomes. We have been able to shorten the length of stay, get patients better quicker and get them home sooner.”
Through ongoing collaboration, the team has worked to maintain asthma length of stay to less than two days without increased seven-day or 30-day readmission rates. Since implementation, more than 3,800 patients have been admitted to the pathway. Dr. Magruder credits the Children’s Respiratory Therapy department for much of the pathway’s ongoing success. “Their dedicated team oversees day-to-day pathway management, staff training and data collection. Because of their efforts, we have extensive data to help us identify areas for continued improvement, and to quickly identify care variations.”
As an extension of the inpatient pathway, partners from Respiratory Therapy, Division of Pulmonary and Sleep Medicine and Hospital Medicine care coordinators developed a daily asthma education class to standardize disease management education for inpatients and build a foundation for improved chronic disease management. More than 7,000 patients and caregivers have participated in asthma education since August 2011. Dr. Magruder stated, “If families understand the importance of successful outpatient chronic disease management and receive education about their disease, we can partner with them to decrease their hospitalizations, help them stay in school and keep parents from missing work.”
Hospital Medicine care coordinator Sherry Garlington said the pathway presents better structure for her department to provide enhanced education for patients. “The pathway helps us gauge where a patient family is in the treatment plan, so we can provide education as needed on every level of concern,” she said.
Although the COVID-19 pandemic has provided its challenges in hospital settings, the Pulmonary Division is establishing new ways to continue educating its families. “Before COVID, we offered patient families in-person education classes throughout the week,” said Garlington. “Since we currently cannot have in-person classes, we have gone to individual bedsides, which has made for a more challenging environment,” she explained. “We have been working with the Information Technology department to provide Zoom classes, but we are hoping to have the classes in person again sometime in the future.”
The success of the pathway and the education provided has been the result of an impressive multidisciplinary team effort. “I am proud of the role that Children’s respiratory therapists have played in making the pathway an ongoing success,” Park stated. “Their hard work and dedication to our patients has been amazing! Teamwork across multiple departments has made this pathway initiative so successful from the beginning to now.”