title: Improving the Efficiency of Care for Pediatric Patients Hospitalized With Asthma.
abstract: Asthma exacerbations are a leading cause of hospitalization among children. Despite the existence of national pediatric asthma guidelines, significant variation in care persists. At Duke Children's Hospital, we determined that our average length of stay (ALOS) and cost for pediatric asthma admissions exceeded that of our peers. Our aim was to reduce the ALOS of pediatric patients hospitalized with asthma from 2.9 days to 2.6 days within 12 months by implementing an asthma pathway within our new electronic health record.
  
  
  
  We convened a multidisciplinary committee charged with reducing variability in practice, ALOS, and cost of inpatient pediatric asthma care, while adhering to evidence-based guidelines. Interventions were tested through multiple "plan-do-study-act" cycles. Control charts of the ALOS were constructed and annotated with interventions, including testing of an asthma score, implementation of order sets, use of a respiratory therapy-driven albuterol treatment protocol, and provision of targeted education. Order set usage was audited as a process measure. Readmission rates were monitored as a balancing measure.
  
  
  
  The ALOS of pediatric patients hospitalized with asthma decreased significantly from 2.9 days to 2.3 days. Comparing baseline with intervention variable direct cost data revealed a savings of $1543 per case. Improvements occurred in the context of high compliance with the asthma pathway order sets. Readmission rates remained stable throughout the study period.
  
  
  
  Implementation of an asthma care pathway based on the electronic health record improved the efficiency and variable direct costs of hospital care, reduced variability in practice, and ensured adherence to high-quality national guidelines.
authors.affiliation: Division of Pediatric Hospital and Emergency Medicine, and katy.bartlett@duke.edu.|Department of Pediatrics, Duke Children's Hospital, and.
authors.forename: Kathleen W
authors.initials: KW
authors.lastname: Bartlett
authors.affiliation: Department of Pediatrics, Duke Children's Hospital, and.
authors.forename: Victoria M
authors.initials: VM
authors.lastname: Parente
authors.affiliation: Performance Services, Duke University Health System, Durham, North Carolina.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Morales
authors.affiliation: Performance Services, Duke University Health System, Durham, North Carolina.
authors.forename: Jillian
authors.initials: J
authors.lastname: Hauser
authors.affiliation: Division of Pediatric Hospital and Emergency Medicine, and.|Department of Pediatrics, Duke Children's Hospital, and.
authors.forename: Heather S
authors.initials: HS
authors.lastname: McLean
mesh_terms: D000293:Adolescent; D001249:Asthma / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols / Q000592:standards; D019091:Critical Pathways / Q000592:standards*; D017598:Efficiency, Organizational; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006801:Humans; D033183:Interdisciplinary Communication; D007902:Length of Stay; D008297:Male; D000069342:Medical Overuse / Q000517:prevention & control; D009657:North Carolina / Q000453:epidemiology; D010043:Outcome and Process Assessment, Health Care; D010347:Patient Care Planning / Q000458:organization & administration / Q000592:standards; D010359:Patient Readmission / Q000706:statistics & numerical data*; D058996:Quality Improvement / Q000458:organization & administration*