Clinical trial NCT02037841: The Impact of Implementing a Nursing-driven Clinical Pathway for Inpatient Management of Children With Asthma
Official title: The Impact of Implementing a Nursing-driven Clinical Pathway for Inpatient Management of Children Admitted to a Tertiary Care Centre With a Diagnosis of Asthma: A Randomized Controlled Trial
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Asthma
Keywords: Asthma
Nursing
Protocol
PRAM
Length of Stay
Weaning
Clinical pathway
Asthma exacerbation
Lead sponsor: Children's Hospital of Eastern Ontario
Sponsor class: OTHER
Collaborators: name: CHAMO Innovation Fund
First posted: 2014-01-16
Enrollment: 113
Sex: ALL
Minimum age (years): 2
Maximum age (years): 17
Standard ages: CHILD
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: Asthma is the most common chronic disease of childhood and is responsible for large portion of pediatric admissions to Canadian hospitals. There is evidence that clinical pathways allow for optimal delivery of care and may result in decreased length of stay, leading to important economic benefits. Weaning of asthma medications prescribed for asthma exacerbation is not standardized in the current model of care. Currently, weaning is performed by ward physicians; in a teaching hospital, this most often done by residents staff. Differences in practice between different physicians, delays in patient assessment and adjustment of doctor's orders, likely prolong the hospital stay for children admitted with asthma.

This study's main objective is to determine the effect of a nursing-driven clinical pathway on children's length of stay when admitted to hospital with a diagnosis of acute asthma exacerbation. The pathway will allow nurses to wean a specific type of medication(β2-agonist), as compared to the current standard of care, which dictates that a physician writes an order to wean the medication. Number of administered β2-agonist treatments will be compared between both groups, as well as asthma-related health care utilization within two weeks of hospital discharge. Nursing, physician, and patients' satisfaction with the pathway will be evaluated, and a cost minimization analysis will be performed.

This study has the potential to improve resource use efficiency, increase patient safety by avoiding administration of unnecessary medications, and ameliorate quality of care by standardizing the care of children admitted to the hospital with a diagnosis of acute asthma exacerbation. The results of the study will be disseminated across the Canadian Health Care System with the goal of improving outcomes of children admitted to hospitals with acute asthma exacerbations.


Eligibility criteria: Inclusion Criteria:

* Children admitted during the study period with a diagnosis of asthma exacerbation, reactive airway disease, or wheezing
* Children aged 2 to 17 years

Exclusion Criteria:

* Children under the age of 2 years
* Children with congenital heart disease
* Children with chronic lung diseases other than asthma, including cystic fibrosis and bronchopulmonary dysplasia
* Children with severe neurological impairment
* Children with other significant co-morbid disorders
* Children whose caregivers do not understand English or French
* Children whose caregivers cannot be reached by phone for the 14-day follow up

Primary outcomes:
measure: Length of hospital admission, in hours
timeFrame: Duration of hospital admission, average 2-3 days
Secondary outcomes:
measure: The number of inhaled or nebulized β2-agonist treatments given
timeFrame: Duration of hospital admission, average 2 -3 days
measure: number of children transferred to the ICU
timeFrame: During admission to hospital, average 2-3 days
measure: number of families attending asthma teaching sessions
timeFrame: Duration of hospital admission, average 2-3 days
measure: number of children seeking medical attention for asthma-related issues
timeFrame: Within 2 weeks of hospital discharge date
measure: Nursing and physician satisfaction with the pathway
timeFrame: At study completion, expected within 2 to 3 years
measure: patient satisfaction with the care received in hospital
timeFrame: Within 2 weeks of hospital discharge date
Other outcomes:
measure: Cost analysis
timeFrame: At study completion, expected within 2-3 years
Locations:
city: Ottawa
country: Canada
facility: Children's Hospital of Eastern Ontario
state: Ontario
Study officials:
References: