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A Cost-Saving Algorithm for Children Hospitalized for Status Asthmaticus
Karen M. McDowell, MD;
Robert L. Chatburn, RRT;
Timothy R. Myers, RRT;
Mary Ann O'Riordan, MS;
Carolyn M. Kercsmar, MD
Arch Pediatr Adolesc Med. 1998;152:977-984.
Objective To test the ability of an assessment-driven algorithm for treatment of pediatric status asthmaticus to reduce length and cost of hospitalization.
Design Nonrandomized, prospective, controlled trial.
Setting Tertiary care children's hospital.
Patients Children aged 1 to 18 years hospitalized for status asthmaticus; 104 were treated using the asthma care algorithm (intervention) and 97 using unstructured standard treatment (control).
Intervention Patients were treated using either an assessment-based algorithm or standard care practices. The algorithm group was treated with standard medications (aerosolized albuterol, systemic corticosteroids, epinephrine, ipratropium) administered at a frequency driven by the patient's clinical condition. Specific criteria were outlined for decreasing or augmenting therapy, transferring to intensive care, and discharging to home. A unique patient record containing assessments, algorithm cues, and a treatment record was used. Intervention group patients were interviewed by telephone 1 week after discharge.
Main Outcome Measures Hospital length of stay, cost per hospitalization, relapse rate, protocol adherence.
Results Average hospital stay for intervention patients was significantly shorter than for control patients (2.0 vs 2.9 days, P<.001). Although intervention patients received fewer aerosolized albuterol doses than controls, there was no difference in short-term relapse rate between groups. The intervention saved more than $700 per patient in hospital charges. Adherence to the protocol was excellent, with only 8 variances per patient stay out of more than 150 opportunities.
Conclusion An intensive, assessment-driven algorithm for pediatric status asthmaticus significantly reduces hospital length of stay and costs without increasing morbidity.
From the Departments of Pediatrics (Dr Kercsmar and Ms O'Riordan), and Respiratory Therapy (Messers Chatburn and Myers), University Hospitals of Cleveland, Rainbow Babies and Childrens Hospital, Case Western Reserve University, Cleveland, Ohio; and Children's Hospital of Buffalo, Lung Center, Buffalo, NY (Dr McDowell).
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