Effect of an Asthma Guideline in 2 Pediatric Emergency Departments and an Urgent Care Center.
OBJECTIVE
The objective of this study was to evaluate ordering of albuterol via metered-dose inhaler with spacer (MDI-spacer), length of stay (LOS), and 72-hour return rates before and after publication of an internally developed pediatric asthma clinical practice guideline (CPG).


METHODS
The internally developed CPG reflected national recommendations. It was explained at faculty meetings by a respected clinician and published on the intranet on February 6, 2012. We performed a retrospective study of visits from January 1, 2009, to October 31, 2014, by children aged 2 to 17 years with a primary diagnosis of asthma and discharged from a target site (2 pediatric emergency departments and 1 urgent care center). We excluded critical/emergent visits and those by patients who transferred to the emergency department/urgent care center from another facility or were admitted. We extracted data for 37 months before and 33 months after CPG implementation (post-CPG) using a single electronic health record system.


RESULTS
Albuterol delivery via MDI-spacer increased by 33.95% (P < 0.0001) during 1-month post-CPG implementation with no significant subsequent decrease. An unexpected decline was noted for median LOS before CPG implementation (-1.24 minutes; P < 0.0001). For MDI-spacer-treated patients post-CPG, decreased median LOS was maintained and there was decreased variability of the median LOS (P < 0.001). For nebulizer-treated patients post-CPG, median LOS increased (.95 minutes; P = 0.033). No change was observed for 72-hour return rates.


CONCLUSIONS
Implementation of an asthma CPG increased ordering of albuterol via MDI-spacer. The increase was sustained over time in all study sites. Decreased variability in median LOS for MDI-spacer patients was observed post-CPG. Median LOS for those treated with MDI-spacer exclusively remained unchanged in the post-CPG period, whereas post-CPG LOS increased in those who received nebulized albuterol.
Jennifer J
JJ
Dilts
Sharon G
SG
Humiston
Brian R
BR
Lee
Nancy H
NH
Allen
Jeffrey G
JG
Michael
D000293:Adolescent; D000420:Albuterol / Q000008:administration & dosage*; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data; D001249:Asthma / Q000188:drug therapy*; D001993:Bronchodilator Agents / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D036501:Metered Dose Inhalers; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies
D001993:Bronchodilator Agents; D000420:Albuterol