P2.Q332: Enhancing Pediatric Asthma Management in Urgent Care: A Quality Improvement Initiative

Purpose/Objectives: Intro: Children with severe symptoms due to acute asthma often present for treatment to urgent care settings as well as to emergency departments. Early administration of oral steroids can reduce emergency department visits and hospitalizations associated with asthma exacerbations. Standardized processes to guide care delivery have been shown to improve care delivery and outcome in emergency departments. In our region, more pediatric visits for acute asthma occur at urgent care (57%) sites than at emergency departments (43%), prompting a goal to optimize pediatric asthma management by creating and implementing a care process model (CPM) for urgent care sites.

Design/Methods: Methods: A multidisciplinary team of pediatric urgent care and emergency medicine physicians developed the CPM. This CPM was designed to align with existing emergency department care processes and build on a prior single-site urgent care pilot CPM for pediatric asthma. The CPM includes recommendations for severity assessment, medication delivery, reassessment, and transfer based on available evidence. Implementation activities included physical copies of the CPM posted in each of 25 general and 5 pediatric-specific urgent care sites, written communication regarding the CPM to all care providers, an electronic orderset for medication ordering that includes a link to an electronic version of the CPM, and presentations to all leadership, physicians, advanced practice providers, and care team members in the urgent care system. The order set was incorporated alongside other ordersets in the electronic medical record and a dashboard was developed to track outcomes and to communicate progress to clinic leadership. Key metrics were minimizing the time from initial vital signs assessment to medication delivery, and increasing the rate of steroid administration preceding albuterol treatment initiation. Implementation sites account for approximately 2,300 annual pediatric asthma visits annually. Baseline metric adherence included calendar year 2022. The CPM was developed in summer 2023 and implementation activities completed during September 2023. Post-implementation metric adherence included September 2023 through March 2024.

Results:

Results: Mean time to albuterol administration decreased from 49 to 29 minutes, and mean time to steroid administration from 57 to 36 minutes. The percentage of patients receiving steroids prior to albuterol increased from a baseline of 40% to 48%, and increased to 63% in the subset pediatric-specific sites.

Conclusion/Discussion:

Conclusion: This project reduced medication administration times and changed clinical practice to improve early steroid administration across a network of general and pediatric-specific urgent care sites. Implementation of the CPM has had insufficient time to assess impact on transfers and hospitalizations, but these patient-centered outcomes are an important goal of this effort. Though this project improved the chosen key metrics, there remains potential for further improvement through examination of the barriers and facilitators of the care delivered to children with acute asthma.