Abstract Rationale There is significant practice variation in assessment and management of pediatric asthma in our hospital system which includes a tertiary pediatric referral center and 8 community hospitals. This variation contributes to suboptimal asthma treatment. Asthma scoring tools provide a common language among the medical team to describe severity of illness and guide treatment for pediatric asthma in the emergency department (ED). The Hospital Asthma Severity Score (HASS) is a validated tool to assess the severity of an asthma exacerbation. The aim of this project was to increase HASS score utilization to 75% and determine the impact of our interventions on the quality of asthma care. Methods We used a PDSA QI methodology with input from a multidisciplinary team including emergency and pediatric physicians, pharmacists, nurses, and respiratory therapists to identify and address factors contributing to variation in asthma treatment. An acute asthma care bundle was introduced in February 2023 including the HASS and a HASS-driven clinical practice guideline. Efforts initially focused on our tertiary hospital ED and then expanding to all network hospitals. Interventions to increase usage of the bundle have included multimodal education sessions and revisions to the electronic health record (EHR). Our primary outcome measure is the percentage of patients aged 2-18 who present to an ED with an asthma exacerbation who have a documented HASS. Our process measures include the percentage of patients who received DuoNebs and systemic steroids within 60 minutes of arrival. The measures are extracted from the EHR and analyzed using statistical process control charts. Results HASS documentation for ED asthma encounters increased (33% to 49.7%) at our tertiary hospital (Figure 1). With focused efforts at broader dissemination, there has been an increase in HASS documentation (2% to 15%) in our community hospitals. After HASS and guideline implementation, there was an improvement in the percentage of patients receiving systemic steroids (29.1% to 38.7%) and DuoNebs (31.5% to 42.1%) within 60 minutes. Conclusions With a multimodal implementation strategy, HASS utilization has increased, and markers of asthma care quality have improved across our health system. However, the HASS is documented in 50% of asthma encounters and there remain delays in timely asthma care. Additional PDSA cycles will address community stakeholder engagement, EHR decision support, and audit feedback to drive further improvement. This abstract is funded by: None
Patterson et al. (Fri,) studied this question.