Tang Katherine M, Mills Cloyde, McCann Teresa A, Rosenthal Susan L, Lee Jennifer
From the Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, N.Y.
NewYork-Presbyterian/Morgan Stanley Children's Hospital, New York, N.Y.
Pediatr Qual Saf. 2025 Jun 5;10(3):e817. doi: 10.1097/pq9.0000000000000817. eCollection 2025 May-Jun.
Asthma pathways reduce hospital length of stay (LOS), and respiratory therapists (RTs) can optimize care. This study aimed to use quality improvement methods to implement an asthma-specific RT role and RT-driven asthma pathway. The SMART aim was to reduce LOS for pediatric patients admitted for asthma to the general inpatient units by 20% within 22 months.
We included children 2-17 years of age who were admitted to a general inpatient unit for asthma. We excluded patients transferred from another hospital, initially admitted to the pediatric intensive care unit, or with comorbidities predisposed to severe respiratory illnesses. We used the Model for Improvement to design and study interventions. Key drivers focused on standardizing care, leveraging provider expertise, and supporting providers with education and technology. The outcome measure was LOS. The main process measure was the early transition to an albuterol metered-dose inhaler. Balancing measures were hospital reutilization rates and escalation of care. We used statistical process control charts and run charts to analyze the data.
The study included 743 patients, with 339 in the intervention period. The intervention group had a younger median age (4 [3, 7] versus 6 [3, 10] years, < 0.001) and more publicly insured patients (84% versus 68%, < 0.001). LOS decreased from 39.4 to 30.7 hours, achieving our SMART aim without adversely affecting the balancing measures.
Quality improvement methodology aids in implementing an RT-driven asthma pathway on the pediatric floors to decrease LOS without adversely influencing hospital reutilization rates or transfers for escalation of care.
哮喘治疗路径可缩短住院时长，呼吸治疗师（RT）能够优化护理。本研究旨在运用质量改进方法来实施特定于哮喘的RT角色及由RT驱动的哮喘治疗路径。具体目标是在22个月内将入住普通住院病房的哮喘儿科患者的住院时长缩短20%。
我们纳入了2至17岁入住普通住院病房治疗哮喘的儿童。排除了从其他医院转来的患者、最初入住儿科重症监护病房的患者或患有易导致严重呼吸道疾病合并症的患者。我们使用改进模型来设计和研究干预措施。关键驱动因素集中在规范护理、利用提供者的专业知识以及通过教育和技术支持提供者。结果指标是住院时长。主要过程指标是尽早过渡到使用沙丁胺醇定量气雾剂。平衡指标是医院再利用率和护理升级情况。我们使用统计过程控制图和运行图来分析数据。
该研究纳入了743名患者，其中339名在干预期。干预组的中位年龄更小（4[3,7]岁对6[3,10]岁，<0.001），且公共保险患者更多（84%对68%，<0.001）。住院时长从39.4小时降至30.7小时，实现了我们的具体目标，且未对平衡指标产生不利影响。
质量改进方法有助于在儿科病房实施由RT驱动的哮喘治疗路径，以缩短住院时长，同时不会对医院再利用率或因护理升级而进行的转院产生不利影响。
