Effect of an Integrated Care Pathway on Acute Asthma/Wheeze in Children Attending Hospital: Cluster Randomized Trial
Received 7 April 2007; received in revised form 13 August 2007; accepted 17 September 2007. published online 19 November 2007.
Refers to article:
Reliable Implementation of Clinical Pathways: What Will It Take—That Is the Question
Jeffrey M. Simmons, Uma R. Kotagal
The Journal of Pediatrics
March 2008 (Vol. 152, Issue 3, Pages 303-304) Full Text |
Full-Text PDF (63 KB)
Objective
To determine whether an integrated care pathway (ICP) could improve care delivered to patients coming to an emergency department only or to patients who were subsequently admitted.
Study design
Children (age, 2-16 years; n = 298) coming to the ED with acute asthma/wheeze, were randomized by using a cluster design to either standard care or care delivered by an ICP.
Results
Children discharged from the ED who received care with an ICP (n = 118) received more prednisolone (81%; standard, 63%; P = .03) and increased advice to obtain primary care review (72%; standard, 33%; P < .0001). A total of 180 children were admitted (94 ICP, 86 standard). The rate of recovery was unchanged by ICP. The mean ICP length of stay (37.6 hours; range, 33.5-42.4 hours), was 93% of the mean standard length of care (40.7 hours; range, 35.9-46; P = .36). When a discharge checklist was completed (60 of 94 cases), the mean ICP length of stay was 34.2 hours (range, 30.5-38.4 hours; P = .07 versus standard). An ICP resulted in a 30% reduction in prescribing errors (mean, 10.4; standard, 14.8; P = .002). Eighty-four of 94 children with an ICP received a 48-hour discharge plan (89%) versus 35 of 86 children with standard care (41%). More clinical contacts were observed in children receiving care by an ICP (mean, 22, versus standard, 19.2: P = .0004).
Conclusion
An acute asthma/wheeze ICP improved education and prescribing errors, modestly reduced the length of stay when discharge criteria were adhered to, but did not influence recovery time. Further consideration of the effect on staff workload is required.
aDepartment of Respiratory and Sleep Medicine, Royal Hospital for Sick Children, Edinburgh, United Kingdom
bMedical Statistics Unit, University of Edinburgh, Edinburgh, United Kingdom
cDepartment of Emergency Medicine, Royal Hospital for Sick Children, Edinburgh, United Kingdom.
Reprint requests: Dr Steve Cunningham, Consultant Respiratory Paediatrician and Part Time Senior Lecturer, Department of Respiratory and Sleep Medicine, Royal Hospital for Sick Children, Sciennes Road, Edinburgh, EH9 1LF, UK.
Supported by the Sick Kids Friends Foundation (Edinburgh) and Roche Award Grant.
ABSTRACT