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 U-M
Hospital Improves Care For Asthmatic Kids
by Lorinda Bullock, October 13, 2004, Detroit Free Press
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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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