Effect of a clinical pathway on the hospitalisation rates of children with asthma: a prospective study

Seamus P Norton ^1*, Martin V Pusic ², Fatma Taha ¹, Susan Heathcote ¹ and Bruce C Carleton ³

¹ British Columbia's Children's Hospital, University of British Columbia, Canada
² Morgan Stanley Children's Hospital, Columbia University Medical Center, United States
³ Faculty of Pharmaceutical Sciences, University of British Columbia, Canada

^* To whom correspondence should be addressed. E-mail: spnorton{at}hotmail.com.

Accepted 19 June 2006

Abstract

Aims: To determine the effect of implementing a clinical pathway, using evidence-based clinical practice guidelines, for the emergency care of children with asthma.

Methods:We conducted a prospective, before-after, controlled trial that included patients between 1 and 18 years of age who had acute exacerbations of asthma treated in a tertiary care paediatric emergency department. We collected data for identical 2-month seasonal periods before and after implementation of the clinical pathway to determine hospitalisation rate and other outcomes. For 2 weeks after emergency visits, we evaluated whether patients returned to emergency care for worsening asthma. A multi-disciplinary panel, using national guidelines and a systematic review, developed the pathway.

Results:We studied 267 patients. Rate of hospitalisation was significantly lower in the post- implementation group (10 of 74 [13.5 percent]) than in the pre-implementation control group (53 of 193 [27.5 percent], P=0.02, NNT = 7.1). All reduction in hospitalisation occurred in children with moderate to severe asthma exacerbation. After implementation of our clinical pathway, rate of administration of oral corticosteroids to patients with moderate or severe exacerbations improved from 71 percent to 92 percent (P=0.01), and significantly more patients received & [beta]₂-agonist in the first hour. No significant change in relapse to acute care occurred within 2 weeks.

Conclusions:An evidence-based clinical pathway for children with moderate to severe exacerbations of acute asthma significantly decreases their rate of hospitalisation without increased return to emergency care.

Keywords: asthma, clinical care pathway, clinical practice guideline, emergency medicine, paediatrics

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