Effects of a PICU Status Asthmaticus De-Escalation Pathway on Length of Stay and Albuterol Use*

Brennan, Steven; Lowrie, Lia; Wooldridge, Jamie L.

doi:10.1097/pcc.0000000000001551

Cited by 21 publications

(30 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although respiratory scores are applied in many clinical contexts, their performance cannot be determined solely on the perception of objectivity or functionality (face value), but rather by their capacity to be discriminative, predictive and evaluative in standardizing care, enhancing decision making, and offering risk stratification 7 . For instance, clinical scores in pediatric asthma are associated with reductions in LOS and continuous albuterol duration 17–19 . To standardize assessment of clinical scores, the COSMIN taxonomy have been proposed and consist of four primary test domains: validity, reliability, responsiveness, and interpretability 13 …”

Section: Discussionmentioning

confidence: 99%

“…7 For instance, clinical scores in pediatric asthma are associated with reductions in LOS and continuous albuterol duration. [17][18][19] To standardize assessment of clinical scores, the COSMIN taxonomy have been proposed and consist of four primary test domains: validity, reliability, responsiveness, and interpretability. 13 Validity includes face validity (qualitative judgment that a score is "good" or not by "experts"), content validity (appropriate representation of concept within the items of the score), construct validity (extent to which a score relates to other outcomes), and criterion-concurrent validity (degree to which a score relates to a gold-standard).…”

Section: Construct Validitymentioning

confidence: 99%

See 1 more Smart Citation

The bronchiolitis severity score: An assessment of face validity, construct validity, and interobserver reliability

Siraj

Stark

McKinley

et al. 2021

Pediatric Pulmonology

View full text Add to dashboard Cite

Objective: To assess face validity, interobserver reliability, and the ability to discriminate escalations of care within 24-h of admission (late rescues) for the bronchiolitis severity score (BSS) for children hospitalized for acute bronchiolitis.Hypotheses: The BSS will yield variable face validity, have clinically relevant interobserver reliability (kappa > 0.7), and distinguish late rescues during hospitalization.Methods: We performed a combined retrospective and prospective, mixed methods study where (1) interobserver agreement was prospectively assessed by overall and subcategory congruence (kappa) calculations, (2) face value were qualitatively assessed from aggregate questionnaire responses, and (3) construct validity for late rescues were assessed using receiver operator characteristic (ROC) curve analyses.Results: Face validity, assessed from 39 questionnaire respondents, were generally positive for BSS utility, reliability, and usability. The BSS exhibited weak interobserver reliability (kappa = 0.22, 95% confidence interval [CI]: 0.11-0.31) calculated from 72 sequential, blinded calculations. Retrospectively, 181 children less than 2 years of age admitted to the general pediatric ward for acute bronchiolitis from November 2017 to April 2019 were identified of which 18 (9.9%) experienced late rescues. Admission BSS values were no different for children with and without late rescues (6[3,6] vs. 4[3,6]; p = .09). An ROC curve analysis revealed an area under the curve of 0.61 (95% CI: 0.48-0.75; threshold ≥6 with sensitivity = 56%, specificity = 69%) for BSS to discriminate late rescues. Conclusion:Although clinicians expressed favorable perceptions of BSS face and content validity, we noted weak interobserver reliability and limited construct validity. Further development and validation are needed to strengthen the BSS before routine use.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Construct Validitymentioning

confidence: 99%

The bronchiolitis severity score: An assessment of face validity, construct validity, and interobserver reliability

Siraj

Stark

McKinley

et al. 2021

Pediatric Pulmonology

View full text Add to dashboard Cite

show abstract

“… 8 – 12 Recently, quality improvement efforts in PICUs have shown promise to decrease the LOS and length of time spent receiving continuous nebulized bronchodilator treatments. 13 – 15 These studies have used various objective asthma scores combined with standardized algorithms to de-escalate care. 13 , 14 …”

Section: Introductionmentioning

confidence: 99%

“… 13 – 15 These studies have used various objective asthma scores combined with standardized algorithms to de-escalate care. 13 , 14 …”

Section: Introductionmentioning

confidence: 99%

Implementation of a Nurse-Driven Asthma Pathway in the Pediatric Intensive Care Unit

Flaherty

Whalen

Lee

et al. 2021

Pediatric Quality &Amp; Safety

View full text Add to dashboard Cite

Background: Asthma is one of the most common conditions requiring admission to a pediatric intensive care unit. Dosing and weaning medications, particularly bronchodilators, are highly variable, and evidence-based weaning algorithms for clinicians are lacking in this setting. Methods: Patients admitted to a quaternary pediatric intensive care unit diagnosed with acute severe asthma were evaluated for time spent receiving continuous albuterol therapy, the length of stay in the intensive unit care unit, and the length of stay in the hospital. We developed an asthma pathway and continuous bronchodilator weaning algorithm to be used by bedside nurses. We then implemented two major Plan-Do-Study-Act cycles to facilitate the use of the pathway. They included implementing the algorithm and then integrating it as a clinical decision support tool in the electronic medical record. We used standard statistics and quality improvement methodology to analyze results. Results: One-hundred twenty-six patients met inclusion criteria during the study period, with 32 during baseline collection, 60 after weaning algorithm development and implementation, and 34 after clinical decision support implementation. Using quality improvement methodology, hours spent receiving continuous albuterol decreased from a mean of 43.6 to 28.6 hours after clinical decision support development. There were no differences in length of stay using standard statistics and QI methodology. Conclusion: Protocolized asthma management in the intensive care unit setting utilizing a multidisciplinary approach and clinical decision support tools for bedside nursing can reduce time spent receiving continuous albuterol and may lead to improved patient outcomes.

show abstract

“…Patients admitted to the PICU were included in these studies, but outcomes for subjects in the PICU were not specifically evaluated. [9][10][11][12][13] Brennan et al 14 recently found that a de-escalation pathway was associated with modest decreases in PICU LOS, hospital LOS, and duration of continuous albuterol therapy.…”

Section: Introductionmentioning

confidence: 99%

A Respiratory Therapist-Driven Asthma Pathway Reduced Hospital Length of Stay in the Pediatric Intensive Care Unit

et al. 2019

View full text Add to dashboard Cite

BACKGROUND: Asthma is a common reason for admissions to the pediatric intensive care unit (PICU). Since June 2014, our institution has used a pediatric asthma clinical pathway for all patients, including those in PICU. The pathway promotes respiratory therapist-driven bronchodilator weaning based on the Modified Pulmonary Index Score (MPIS). This pathway was associated with decreased hospital length of stay (LOS) for all pediatric asthma patients; however, the effect on PICU patients was unclear. We hypothesized that the implementation of a pediatric asthma pathway would reduce hospital LOS for asthmatic patients admitted to the PICU. METHODS: We retrospectively reviewed the medical records of all pediatric asthma subjects 2-17 y old admitted to our PICU before and after pathway initiation. Primary outcome was hospital LOS. Secondary outcomes were PICU LOS and time on continuous albuterol. Data were analyzed using the chi-square test for categorical data, the t test for normally distributed data, and the Mann-Whitney test for nonparametric data. RESULTS: A total of 203 eligible subjects (49 in the pre-pathway group, 154 in the post group) were enrolled. There were no differences between groups for age, weight, gender, home medications, cause of exacerbation, medical history, or route of admission. There were significant decreases in median (interquartile range) hospital LOS (4.4 [2.9 -6.6] d vs 2. 7 [1.6 -4.0] d, P < .001), median PICU LOS (2.1 [1.3-4.0] d vs 1.6 [0.8 -2.4] d, P ‫؍‬ .003), and median time on continuous albuterol (39 [25-85] h vs 27 [13-42] h, P ‫؍‬ .001). Significantly more subjects in the post-pathway group were placed on high-flow nasal cannula (32% vs 6%, P ‫؍‬ .001) or noninvasive ventilation (10% vs 4%, P ‫؍‬ .02). CONCLUSION: The implementation of an asthma pathway was associated with decreased hospital LOS, PICU LOS, and time on continuous albuterol. There was also an increase in the use of high-flow nasal cannula and noninvasive ventilation after the implementation of this clinical pathway.

show abstract

Effects of a PICU Status Asthmaticus De-Escalation Pathway on Length of Stay and Albuterol Use*

Cited by 21 publications

References 10 publications

The bronchiolitis severity score: An assessment of face validity, construct validity, and interobserver reliability

The bronchiolitis severity score: An assessment of face validity, construct validity, and interobserver reliability

Implementation of a Nurse-Driven Asthma Pathway in the Pediatric Intensive Care Unit

A Respiratory Therapist-Driven Asthma Pathway Reduced Hospital Length of Stay in the Pediatric Intensive Care Unit

Contact Info

Product

Resources

About