Asthma (Emergency Department and Inpatient)

Pathway Background and Objectives

In the United States, asthma affects 7 million children under 18 years. In 2010, 58.3% of children with asthma had at least one asthma attack in the previous twelve months. Nearly 20% of children diagnosed with asthma went to an ED for care in 2009. Asthma is the third¬ ranking cause of hospitalization for children and one of the leading causes of school absenteeism, approximately 12.8 million school days. Less than half of all children with asthma have an asthma action plan. Clinical pathways for asthma can decrease LOS, costs, and unnecessary antibiotic use without increasing rates of readmissions, leading to higher value care.

The objectives of this pathway are to:

  • Standardize management of patients presenting with asthma exacerbation
  • Ensure safe transfer of patients from the Emergency Department to Inpatient Unit
  • Ensure all patients are discharged with a completed asthma home treatment plan
  • Ensure that all eligible patients are started on a daily inhaled corticosteroid

Emergency Department Algorithm  Inpatient Algorithm  Educational Module 

 
For management of this condition in primary care, see CLASP/Co-Management guideline

ED

  • Percentage of eligible patients treated per pathway
  • Percentage of patients treated for asthma in the ED who are admitted as inpatient or placed in observation status
  • Average time from arrival to administration of systemic steroids
  • LOS for patients discharged from the ED (hours)
  • Number of transfers to the Pediatric Intensive Care Unit within 12 hours of admission
  • Returns to the ED (treat and release) within 48 hours with asthma diagnosis
  • Returns to the ED (treat and release) within 7 days with asthma diagnosis
  • Number of patients with >1 ED visit in 7 days and PICU admission within last 2 years who are admitted

Inpatient

  • Percentage of eligible patients treated per pathway
  • Percentage of patients with order set use
  • Percentage of patients > 5 years of age discharged with a prescription for controller medication
  • Percentage of patients who were given a complete asthma home treatment plan
  • Mean length of stay (days)
  • Readmissions within 7 days
  • Readmissions within 30 days
  • Kristin Welch, MD
  • Eric Hoppa, MD
  • Anand Sekaran, MD
  • Christina Giudice, APRN
  • Alexander Hogan, MD

The clinical pathways in the above links have been developed specifically for use at Connecticut Children’s and are made available publicly for informational and/or educational purposes only. The clinical pathways are not intended to be, nor are they, a substitute for individualized professional medical judgment, advice, diagnosis, or treatment. Although Connecticut Children’s makes all efforts to ensure the accuracy of the posted content, Connecticut Children’s makes no warranty of any kind as to the accuracy or completeness of the information or its fitness for use at any particular facility or in any individual case.