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ASSESSMENT OF CURRENT
PEDIATRIC ASTHMA INITIATIVES AND FUTURE NEEDS IN HOSPITALS ACROSS THE UNITED
STATES
Timothy R. Myers BS, RRT and Thomas
J. Kallstrom, RRT, FAARC for the American Respiratory Care Foundation, American
Association for Respiratory Care & the Environmental Protection Agencies
Indoor Division. Dallas, TX & Washington D.C.
Introduction. There are various
approaches to asthma care and education of pediatric patients once they arrive
at an acute care facility. Our particular interest was how respiratory therapists
in pediatric hospitals (traditional) and adult/pediatric (non-traditional) hospitals
manage asthma-related care and education to children. Our primary objective
was to benchmark and compare current initiatives and educational in both traditional
and non-traditional pediatric asthma settings.
Methods. We designed a needs
assessment instrument that sought information about how respiratory care
departments practiced inpatient asthma care and to identify and categorize asthma
education initiatives. For centers that identified performing education initiatives,
we also queried them on implementation of indoor environmental trigger education.
This tool was distributed to 500 hospitals offering pediatric emergency or inpatient
services.
Results. 133 hospitals (26.6%)
responded to the survey. An additional 27 (5%) were eliminated, as they responded
to providing neither pediatric inpatient nor emergency services. The majority
of responding centers (65%) were located in urban areas, reported to be non-traditional
pediatric hospitals (41.7%), and considered themselves academic/teaching facilities
(62.5%). Specific hospital areas that reported treatment and / or education
initiatives for pediatric asthma patients were as follows: ED =90.7%, inpatient
=83.7%, and outpatient =60.5%. On average, less than 50% of the responding hospitals
were currently using protocolized care. Approximately 1/3 of the respondents
were developing hospital-based protocols and 24.6% were developing ED based
protocols. Across the board for all hospitals, the RT was responsible for asthma
education (99.2%), followed by the RN (69.5%), physician (51.9%), and pharmacist
(17.6%). In adult/pediatric hospitals, 52%of respondents spend < 1-hour on
patient education, while in pediatric hospitals, 71% of the respondents spend
between 1-5 hours. The table below lists respondent percentages for key initiatives,
and the comparative p-values determined by Chi Square Analysis.
| Breakdown |
Overall |
Adult/Peds |
Children |
P value |
| Use of
ED Protocol |
45.4% |
41% |
60% |
0.01 |
| Use of
Inpatient Protocol |
49.6% |
42% |
74.2% |
<0.001 |
| Trigger
Education |
93.8% |
92.8% |
96.8% |
0.33 |
| Staff is
Trained |
22.5% |
19.4% |
32.3% |
0.05 |
| Staff Asthma
Competency Tested |
30% |
18.9% |
15.5% |
0.71 |
| Interested
in Toolkit |
84.7% |
86% |
80.6% |
0.45 |
Conclusions: A significant
difference exists between traditional and non-traditional hospitals in treating
pediatric asthma with protocol therapy. While the majority of responding hospitals
provided asthma trigger education, respiratory care staff training and competency
occurred less than a third of the time. Based on the results of this study,
further work on the development of asthma protocol therapy, staff training and
competency testing needs to be done.
OF-02-052
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