A cost-saving algorithm for children hospitalized for status asthmaticus.
OBJECTIVE
To test the ability of an assessment-driven algorithm for treatment of pediatric status asthmaticus to reduce length and cost of hospitalization.


METHODS
Nonrandomized, prospective, controlled trial.


METHODS
Tertiary care children's hospital.


METHODS
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).


METHODS
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.


METHODS
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.


CONCLUSIONS
An intensive, assessment-driven algorithm for pediatric status asthmaticus significantly reduces hospital length of stay and costs without increasing morbidity.
McDowell
K M
KM
Children's Hospital of Buffalo, Lung Center, NY, USA.
Chatburn
R L
RL
Myers
T R
TR
O'Riordan
M A
MA
Kercsmar
C M
CM
D000293:Adolescent; D000465:Algorithms; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D017046:Cost Savings; D005260:Female; D017722:Hospital Charges / Q000706:statistics & numerical data; D017721:Hospital Costs / Q000706:statistics & numerical data; D006776:Hospitals, Pediatric / Q000191:economics*; D006801:Humans; D007223:Infant; D007902:Length of Stay / Q000191:economics*; D008297:Male; D009820:Ohio / Q000453:epidemiology; D011446:Prospective Studies; D012008:Recurrence; D012720:Severity of Illness Index; D013224:Status Asthmaticus / Q000191:economics* / Q000453:epidemiology / Q000628:therapy