Asthma
Conditions
Keywords
Asthma, Nursing, Protocol, PRAM, Length of Stay, Weaning, Clinical pathway, Asthma exacerbation
Brief summary
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.
Interventions
OTHERNursing-driven clinical pathway for management of inpatient asthma
Sponsors
CHAMO Innovation Fund
Children's Hospital of Eastern Ontario
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
2 Years to 17 Years
Healthy volunteers
No
Inclusion criteria
* Children admitted during the study period with a diagnosis of asthma exacerbation, reactive airway disease, or wheezing * Children aged 2 to 17 years
Exclusion criteria
* Children under the age of 2 years * Children with congenital heart disease * Children with chronic lung diseases other than asthma, including cystic fibrosis and bronchopulmonary dysplasia * Children with severe neurological impairment * Children with other significant co-morbid disorders * Children whose caregivers do not understand English or French * Children whose caregivers cannot be reached by phone for the 14-day follow up
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Length of hospital admission, in hours | Duration of hospital admission, average 2-3 days | The participants will be followed for the duration of their hostpital admission, an expected average of 2-3 days. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| The number of inhaled or nebulized β2-agonist treatments given | Duration of hospital admission, average 2 -3 days | The participants will be followed for the duration of their hostpital admission, an expected average of 2-3 days. |
| number of children transferred to the ICU | During admission to hospital, average 2-3 days | The participants will be followed for the duration of their hostpital admission, an expected average of 2-3 days. |
| number of families attending asthma teaching sessions | Duration of hospital admission, average 2-3 days | The participants will be followed for the duration of their hostpital admission, an expected average of 2-3 days. |
| Nursing and physician satisfaction with the pathway | At study completion, expected within 2 to 3 years | — |
| patient satisfaction with the care received in hospital | Within 2 weeks of hospital discharge date | Follow up satisfaction questionaire will be completed within two weeks of discharge from hospital |
| number of children seeking medical attention for asthma-related issues | Within 2 weeks of hospital discharge date | Follow up will occur to assess all children who seeked medical attention for concerns related to asthma for two weeks post-discharge from hospital |
Other
| Measure | Time frame |
|---|---|
| Cost analysis | At study completion, expected within 2-3 years |
Countries
Canada
Outcome results
None listed