Nurse-Driven Clinical Pathway for Asthma Improves Efficiency, Reduces Length of Stay Interview with:

Catherine M. Pound MD The Ottawa Children’s Treatment Centre

Dr. Catherine Pound

Catherine M. Pound MD
The Ottawa Children’s Treatment Centre What is the background for this study?

Response: Asthma is the most common chronic disease of childhood and contributes to a large portion of Canadian hospital pediatric admissions.  Once patients are admitted to hospitals, they receive salbutamol, a medication used for acute asthma exacerbations, at a pre-determined frequency.  In most hospitals, physicians are the ones to decide of the frequency of administration of the salbutamol, and they decide when to wean patients off it. However, children whose salbutamol treatment administration can be decreased are usually considered stable, and often do not require immediate medical attention, which may results in delays in reassessments as well as administration of unneeded salbutamol treatments, particularly if physicians are busy looking after other sicker patients.  Additionally, physicians’ assessments of children with asthma and their decisions to wean salbutamol frequency are not standardized, and vary among physicians. Therefore, in order to improve efficiency and standardize patient assessments, we developed a clinical pathway allowing nurses to wean salbutamol for children hospitalized with asthma based on a validated asthma scoring system. What are the main findings?

Response: Our study results supported a modest reduction in length of stay for children hospitalized with asthma and treated with our nurse-driven clinical pathway, as compared to patients whose salbutamol administration was weaned by physicians.  A review of adverse events during the study period revealed no increased adverse events in either group of patients.  There also was no significant different in the number of children having unplanned medical visits for asthma in the two weeks following hospital discharge, suggesting that our nurse-driven pathway is safe.  We also noted a trend towards a decrease in the number of salbutamol treatments in children under the pathway compared to standard management What should readers take away from your report?

Response: That our nurse-driven clinical pathway increased efficiency by providing modest evidence for reduced length of stay, without compromising patient safety. By using an asthma clinical pathway, we ensured standardization of care, and allowed utilization of nursing resources and decreased physician burden, resulting in high patient, nurses and physicians’ satisfaction. What recommendations do you have for future research as a result of this study?

Response: Future studies confirming these results in various patient populations would be useful, as well as in other common pediatric common causes of admission to hospital Thank you for your contribution to the community.


Nurse-Driven Clinical Pathway for Inpatient Asthma: A Randomized Controlled Trial 

Catherine M. Pound, Victoria Gelt, Salwa Akiki, Kaylee Eady, Katherine Moreau, Franco Momoli, Barbara Murchison, Roger Zemek, Brett Mulholland, Tom Kovesi

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Last Updated on March 30, 2017 by Marie Benz MD FAAD