One-year experience with an inpatient asthma clinical pathway
T. S. Kwan-Gett, P. Lozano, K. Mullin and E. K. Marcuse
Division of General Pediatrics, University of Washington, Seattle, USA.
OBJECTIVE: To study the effects of an inpatient asthma clinical pathway on
the processes and outcomes for children who were admitted to a hospital for
the treatment of asthma. DESIGN: Before-and-after study. SETTING: A private
nonprofit academic children's hospital in Seattle, Wash. PATIENTS AND
METHODS: Three hundred forty-two admissions of 297 patients in the first
year of the asthma clinical pathway were compared with 353 admissions of
292 similar patients in the previous year. Patients who required intensive
care, were younger than 2 years, or had a major chronic disease were
excluded. INTERVENTION: Asthma was chosen for the development of a clinical
pathway because of its large number of admissions, involvement of multiple
health care providers (nurses, physicians, and respiratory therapists),
predictable hospital course, and variable lengths of hospital stay. The
pathway was a consensus-based guideline for patient management that was
intended to be adapted to the care of an individual patient. Prior to the
implementation of the clinical pathway, nurses, attending physicians, house
staff, and respiratory therapists were trained in its use. The main
hospital chart of each patient who was admitted to the pathway had a
flowchart that outlined day-to-day guidelines for monitoring and care.
Nursing staff were responsible for documenting when a patient's care varied
from the pathway, and these variances were entered into a computer
database. OUTCOME MEASURES: Use of peak flowmeters, steroids, laboratory
studies, radiological studies, and respiratory therapy was assessed by
analyzing the patients' electronic billing records. For patients enrolled
in the pathway, additional data on process of care were obtained by
analyzing the variance database. For both groups, the total charges, length
of stay, and rate of readmission to the hospital were measured by use of
the billing records. RESULTS: There were no significant differences in the
use of steroids or peak flowmeters, average lengths of stay, or total
charges between the 2 groups. However, patients in the "pathway group" had
significantly lower average charges for laboratory ($26 vs $39; P < .05)
and radiology ($32 vs $55; P < .001) services. Variances from the
pathway guidelines were most often related to the patients' responses to
therapy. CONCLUSIONS: The asthma clinical pathway had no effect on clinical
outcomes and small effects on the use of resources. Further development,
including physician and nurse training, computer and administrative
support, and clinical severity scales, are needed to develop the potential
utility of the clinical pathway as a research and quality assurance tool.
Impact of Admission-Day Crowding on the Length of Stay of Pediatric Hospitalizations
Lorch et al.
Pediatrics 2008;121:e718-e730.
ABSTRACT
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The Role of a Clinical Pathway in Curtailing Unnecessary Investigations in Children With Gastroenteritis
Lemberg et al.
American Journal of Medical Quality 2005;20:83-89.
ABSTRACT
Asthma Intervention Program Prevents Readmissions in High Healthcare Users
Castro et al.
Am. J. Respir. Crit. Care Med. 2003;168:1095-1099.
ABSTRACT
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Acute Severe Asthma
McFadden
Am. J. Respir. Crit. Care Med. 2003;168:740-759.
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An Evidence-Based Clinical Pathway for Bronchiolitis Safely Reduces Antibiotic Overuse
Wilson et al.
American Journal of Medical Quality 2002;17:195-199.
ABSTRACT
Asthma Clinical Pathways: Toward What End?
Glauber et al.
Pediatrics 2001;107:590-592.
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A Report Card on Quality Improvement for Children's Health Care
Ferris et al.
Pediatrics 2001;107:143-155.
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Effectiveness of a Clinical Pathway for Inpatient Asthma Management
Johnson et al.
Pediatrics 2000;106:1006-1012.
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Characteristics of Asthma Care Provided by Hospitals in a Large Metropolitan Area: Results From the Chicago Asthma Surveillance Initiative
Grant et al.
Chest 1999;116:162S-167S.
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A Comprehensive Educational Program Improves Clinical Outcome Measures in Inner-City Patients With Asthma
George et al.
Arch Intern Med 1999;159:1710-1716.
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A Cost-Saving Algorithm for Children Hospitalized for Status Asthmaticus
McDowell et al.
Arch Pediatr Adolesc Med 1998;152:977-984.
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