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Re: Effect of a Clinical Pathway in reducing hospital admission rates

Dear Editor,

The article in the January edition of the Archives on the ‘Effect of a Clinical Pathway in Reducing Hospital Admission Rates in Children with Moderate to Severe Exacerbation of Asthma’ was interesting. What was striking was that in addition to a reduction in acute admissions , there was a fall in the delayed admission rate as well, which was quite significant. As a unit, which has an evidence based pathway in place for the management of acute exacerbation of asthma, what would be immensely useful to us, is the availability of the actual clinical pathway itself. It would help highlight if any particular change in practice with respect to our existing guideline could potentially contribute to reduction in delayed admissions.

Also, it would be interesting to know exactly the level of staff training involved prior to the implementation of the clinical care pathway. The authors had pointed out that nurse led initiation of treatment , which resulted in early intervention could be one of the factors contributing to a reduced admission rate . This being the case, details about the actual training involved would throw more light on the time and resource to be invested in the implementation of such clinical care pathways.

The study excluded children with a fever and patchy infiltrates on chest x-ray. We would like to clarify if a chest x-ray was warranted only in children with fever or whether every child with an acute exacerbation of asthma had a chest x-ray done.