Effect of an Integrated Care Pathway on Asthma Care in Hospital
Condition: Asthma
MeSH terms: Asthma
Study type: Interventional

Summary: 
      Integrated care pathways (ICP) coalesce medical and nursing work practices, unifying and
      directing care in line with current best practice and guidelines. We wish to examine the
      introduction of an ICP for children with wheeze/asthma admitted to our hospital. We will
      determine whether more rigid, but guided care results in faster recovery, quicker discharge
      with better education and fewer prescribing errors, but also determine whether staff feel
      alienated by the rigidity of practice, and parents perceive any benefit to the changes
      introduced.This will be a cluster randomised trial (random weeks) of standard or ICP care in
      180 patients admitted to Sick Kids with wheeze/asthma. Parents will be asked to complete a
      questionnaire on admission and contacted at 10-14 days post discharge and asked to recall
      education provided at discharge; no other patient or parent intervention will be required.It
      is expected to take 40 weeks to recruit 180 patients.
    

Detailed description: 
      Children admitted to hospital with wheeze/asthma are provided with care by a large number of
      clinicians with varying levels of skills and experiences. Providing a uniform, safe level of
      care, according to evidence based guidelines is challenging given the levels of experience
      within each hospital. Integrated care pathways are a multidisciplinary document incorporating
      medical, nursing, pharmacy and observational charts within a single chronological document.
      The study is to assess whether such documents can speed recovery and discharge, with care
      adhering more closely to evidence based guidelines for treatment and education. In addition
      we wish to assess patient safety (through prescribing errors) and parental and staff
      attitudes to the ICP introduction. Children arriving at the emergency department will be
      provided with care by either intergrated care pathway or standard care in 7 day clusters,
      randomised in 8 week blocks.

      Comparison: We will compare the time from arrival at hospital to discharge from the ward as
      our primary outcome.

      Other comparisons to be made for: Speed of recovery of heart rate and respiratory rate Time
      to require no supplemental oxygen Time to achieve 4 hourly spacing of bronchodilator Number
      and degree of prescribing errors Provision of education to parents Provision of care adhering
      to asthma guidelines (accurate discharge dose of prednisolone from emergency dept, use of
      multidose salbutamol rather than nebuliser) Number of clinical contacts required with
      patients Staff opinion of ICP before and after introduction Parental opinion of care in
      different groups Parental recall of advice/education provided to them during admission
      Possible Hawthorne effect during period of the study
    

Intervention name(s): Integrated Care Pathway
Intervention type(s): Device
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Asthma; Children; Integrated Care Pathway; Evidence based medicine; Prescribing errors