Asthma is the most common chronic disease of childhood and is responsible for large portion of pediatric admissions to Canadian hospitals. There is evidence that clinical pathways allow for optimal delivery of care and may result in decreased length of stay, leading to important economic benefits. Weaning of asthma medications prescribed for asthma exacerbation is not standardized in the current model of care. Currently, weaning is performed by ward physicians; in a teaching hospital, this most often done by residents staff. Differences in practice between different physicians, delays in patient assessment and adjustment of doctor's orders, likely prolong the hospital stay for children admitted with asthma. This study's main objective is to determine the effect of a nursing-driven clinical pathway on children's length of stay when admitted to hospital with a diagnosis of acute asthma exacerbation. The pathway will allow nurses to wean a specific type of medication(β2-agonist), as compared to the current standard of care, which dictates that a physician writes an order to wean the medication. Number of administered β2-agonist treatments will be compared between both groups, as well as asthma-related health care utilization within two weeks of hospital discharge. Nursing, physician, and patients' satisfaction with the pathway will be evaluated, and a cost minimization analysis will be performed. This study has the potential to improve resource use efficiency, increase patient safety by avoiding administration of unnecessary medications, and ameliorate quality of care by standardizing the care of children admitted to the hospital with a diagnosis of acute asthma exacerbation. The results of the study will be disseminated across the Canadian Health Care System with the goal of improving outcomes of children admitted to hospitals with acute asthma exacerbations.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
113
Children's Hospital of Eastern Ontario
Ottawa, Ontario, Canada
Length of hospital admission, in hours
The participants will be followed for the duration of their hostpital admission, an expected average of 2-3 days.
Time frame: Duration of hospital admission, average 2-3 days
The number of inhaled or nebulized β2-agonist treatments given
The participants will be followed for the duration of their hostpital admission, an expected average of 2-3 days.
Time frame: Duration of hospital admission, average 2 -3 days
number of children transferred to the ICU
The participants will be followed for the duration of their hostpital admission, an expected average of 2-3 days.
Time frame: During admission to hospital, average 2-3 days
number of families attending asthma teaching sessions
The participants will be followed for the duration of their hostpital admission, an expected average of 2-3 days.
Time frame: Duration of hospital admission, average 2-3 days
number of children seeking medical attention for asthma-related issues
Follow up will occur to assess all children who seeked medical attention for concerns related to asthma for two weeks post-discharge from hospital
Time frame: Within 2 weeks of hospital discharge date
Nursing and physician satisfaction with the pathway
Time frame: At study completion, expected within 2 to 3 years
patient satisfaction with the care received in hospital
Follow up satisfaction questionaire will be completed within two weeks of discharge from hospital
Time frame: Within 2 weeks of hospital discharge date
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