Paeds with a wheeze: Improving patient flow with nurse led stretching of inhaled salbutamol

BACKGROUND: Acute wheeze is a common emergency department presentation among pre-school aged children. Innovative models of care that safely optimise treatment and streamline patient flow are needed. A nurse-led stretching of inhaled salbutamol pathway was introduced to enable nurses to independently manage bronchodilator weaning. This study evaluated its impact on length of stay within a children's short term treatment area. METHODS: A single-site controlled pre-post retrospective cohort study was conducted comparing children aged 1-5 years with wheeze admitted to the children's short term treatment area before and after the implementation of the nurse-led stretching of inhaled salbutamol pathway. A gastroenteritis cohort admitted during the same periods served as a non-equivalent control group to assess temporal confounding. The primary outcome was length of stay; secondary outcome included admission to the paediatric service. RESULTS: The wheeze cohort included 533 children. Median length of stay was similar pre- and post-implementation (420 vs 429 min; p = 0.48). However, escalation to a medical officer or nurse practitioner significantly declined post-implementation (from 70.9% to 49.8%; p < 0.001), while utilisation of criteria-led discharge increased (from 41.0% to 64.3%; p < 0.001). CONCLUSIONS: The nurse-led stretching of inhaled salbutamol pathway did not reduce length of stay but demonstrated comparable outcomes to conventional care. This model appears safe and may enhance workforce capacity and ED efficiency.