U-M hospital improves care for asthmatic kids

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A team of physicians from the University of Michigan’s C. S. Mott Children’s Hospital in Ann Arbor, says comparing their treatment of asthma patients with other children’s hospitals from around the country has helped them cut costs, hospital stays and repeat hospitalizations.

Creating such standardized treatment orders has enabled Mott and other children’s hospitals across the country to cut the time young asthma patients spend in the hospital and the number of times they end up there, according to a study on child asthma released this week in the October issue of the journal Pediatrics.

According to the federal Centers for Disease Control and Prevention, asthma is the third-ranking cause of hospitalization among children younger than 15 and accounts for 14 million lost days of school annually.

“Patients have unique needs, but if you start out with a set of standardized orders, then they can be adapted uniquely,” said Dr. Aileen Sedman, a lead author of the study. “That’s better than just starting from scratch with every patient.”

According to Sedman, the largest number of hospitalized child asthma patients are level one patients—children who aren’t responding to treatment at home and in the emergency room after three to four hours.

Prior to the study, level one patients at Mott were treated on a general medical service basis. Children with more severe cases—levels two through four, four being the most severe—would automatically see a pulmonologist. The level one patients had to wait for doctors who would make rounds twice a day, and then decide when and how to change treatment.

After comparing the data of member hospitals that come from the National Association of Children’s Hospitals and Related Institutions, the pulmonologists at Mott developed standardized orders. These are orders doctors and nurses can follow for each patient so they won’t have to wait for a pulmonologist to decide on treatment. They recommend medicine dosages by age, whether or not the child should use inhaled asthma-calming medications and what types of equipment should be used. Sedman said there are areas on the standardized order where clinicians put in unique details about the patient.

That way, “everyone is on the same page,” she said.

“Nurses and respiratory therapists can go ahead and increase or decrease medicine, or the oxygen, according to the standardized order,” Sedman said. “A child within a day can be weaned off” of oxygen.

In addition to the standardized orders, an asthma educator is assigned to each family once a child is admitted following an asthma attack. The educators explain to the children and parents how to avoid triggers of asthma at home, possibly avoiding a future hospital visit.

The study shows this line of defense also made a significant difference. The percentage of level one asthma patients readmitted within 30 days of another asthma attack dropped from 3 percent to less than 1 percent. The national readmission rate during the same period was around 2 percent.

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