Pediatric quality & safety · 2026
Quality Improvement Initiative: Implementation of a Unified Pediatric Asthma Pathway Reduces Critical Care Requirements.
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Livezey Jocelyn A, Witkowski Jessica, Grether-Jones Kendra, Han Moonjoo, Linenberger Michelle, Mateev Stephanie, McCullough Kirsten, McKnight Heather, Natale JoAnne, Reneau Kriston, Smith Brian J, Tsang Lisa, Tzimenatos Leah, Hamline Michelle Y
Аннотация
INTRODUCTION: 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.
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.