Pediatric Asthma Team Earns Statewide Recognition for Quality Innovation

The Inpatient Multidisciplinary Pediatric Asthma Care Team (IMPACT) at Golisano Children's Hospital has earned statewide recognition for implementing a quality improvement program that cut its young patients’ average hospital length of stay by nearly 35 percent.  IMPACT received the Pinnacle Award for Quality and Patient Safety on June 25 from the Health Care Association of New York State.

Golisano Children’s Hospital, part of UR Medicine’s Strong Memorial Hospital, was one of three Pinnacle Award honorees out of 113 nominees from across the state. It was recognized in the category of Hospital System or Hospital with 100 Beds or More.

IMPACT improved patient outcomes by developing a standardized care pathway for children admitted to the hospital for asthma. The team trained nearly 140 nurses and physicians, interns and residents in the new pathway; it piloted the project in 2012 and fully implemented it in 2014. 

Prior to the new care plan, residents and physicians assessed a child’s asthma using subjective criteria and there was significant variation among providers. The new pathway uses a standardized respiratory scoring system to reduce inconsistencies in asthma assessments. Patient assessments are now managed by nurses, who have more opportunity to observe patients’ progress over time than physicians making rounds. 

The team also changed the medications used to control patients’ asthma.

“We eliminated albuterol nebulizers and switched to metered dose inhalers, commonly known as ‘puffers’,” said Eric Biondi, M.D., a pediatric hospitalist at Golisano Children’s Hospital, who worked with nurses, educators, and quality improvement specialists to develop the IMPACT program. “Puffers don’t increase patients’ heart rate as much as nebulizers, and that’s crucial for pediatric patients. The more children’s heart rate goes up, the more anxious they get and the more breathing problems they have.”

The approach also helps parents and children gain valuable practice using metered dose inhalers, which can help control asthma after a child’s hospitalization, Biondi said. “Kids don’t always need to use nebulizers and they can be inconvenient – children can’t bring one to a soccer game or gym class, for example.”

“We have 100 to 150 pediatric asthma admissions each year, and finding better inpatient care methods is essential to improving their outcomes,” Biondi added. “The new pathway has achieved a shorter average hospital stay, which improves children’s health as well as their patient experience.”

Reducing unnecessary variations in care improves health care quality and reduces cost of care, Biondi noted. Along with Biondi, IMPACT team leaders included Michael S. Leonard, M.D., M.S., Associate Chief Quality Officer for Strong Memorial Hospital and Chief Quality Officer at Golisano Children’s Hospital; Janice A. Schriefer, MBA, Dr.Ph., Director of  Quality Improvement at University of Rochester School of Medicine and Dentistry; Julie Albright Gottfried, DNP, RN, Pediatric Service Educator at Golisano Children’s Hospital; and Irene Dutko Fioravanti, MSN, RN, Senior Advanced Practice Nurse at Golisano Children’s Hospital and Assistant Professor of Clinical Nursing at the University of Rochester School of Nursing.  Biondi credited the project’s success to the entire team of nurses, residents and staff who supported the project from pilot to implementation and adopted a new approach to pediatric asthma care.

Lessons learned from this project will help Golisano Children’s Hospital teams as they create new standardized care pathways; plans are under way to develop them for pneumonia, croup, and management of infants with fever.