Quality Improvement Initiative: Implementation of a Unified Pediatric Asthma Pathway Reduces Critical Care Requirements
Jocelyn A. Livezey, Jessica Witkowski, Kendra Grether-Jones, Moonjoo Han, Michelle Linenberger, Stephanie Mateev, Kirsten McCullough, Heather McKnight, JoAnne Natale, Kriston Reneau, Brian J. Smith, Lisa Tsang, Leah Tzimenatos, Michelle Y. HamlineIntroduction:
Asthma management is a leading cause of pediatric hospitalizations, contributing to a significant economic burden and critical care resource use. Standardized asthma care pathways have been shown to improve care delivery and resource allocation. We aimed to determine whether a unified asthma clinical pathway that integrates care across multiple care settings would reduce pediatric intensive care unit (PICU) and hospital length of stay (LOS) in an academic tertiary-care hospital.
Methods:
We designed a unified asthma pathway to integrate care across the emergency department, PICU, and ward. Quality improvement interventions included the unified clinical pathway, an electronic medical record order set, a standardized discharge checklist, and clinician education. The study team evaluated patients admitted with a primary diagnosis of asthma between 24 months and 18 years of age in the “baseline” group (May 2023–March 2024) or “intervention” group (April 2024–July 2025). The primary outcome was LOS, and the secondary outcomes were assessed using statistical process control charts. Wards-to-PICU transfers, 30-day hospital readmissions, and 7-day emergency department revisits served as balancing measures.
Results:
Overall hospital and PICU LOS remained consistent between the baseline (n = 168) and intervention periods (n = 217). After pathway implementation, there was a significant reduction in the number of patients requiring PICU-level care (31% versus 13%) and a reduction in the average time on continuous albuterol (7.4–3.2 h). Balancing measures remained unchanged between groups.
Conclusions:
Implementation of the unified asthma pathway in an academic tertiary-care hospital reduced the number of patients requiring PICU-level care and the time on continuous albuterol without an increase in adverse events.