November 6, 2000
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"We don't want to keep kids here too long or release them too early, but it's clear from our study that by implementing existing guidelines and assigning tasks appropriately, we can optimize the care we deliver in the hospital," says Kevin Johnson, M.D. Johnson and a team of Children's Center asthma and emergency medicine experts conducted the study reported in the November issue of Pediatrics.
In their study of 110 children ages 2 to 18 hospitalized at Hopkins between 1995 and 1997, the researchers said children who were more quickly taken off nebulized beta-agonists (or "nebs") after the first signs of improvement required fewer doses of airway dilator drugs and spent on average 13.5 hours less time in the hospital than similar children whose treatment did not follow the guidelines set down by the National Heart, Lung, and Blood Institute.
Nurses in the study's intervention group, following modified NHLBI guidelines, checked the children's vital signs and weaned children from nebs when there was improvement in air flow and a decrease in breath sounds and respiratory distress. Nurses in the control group relied on assessments and orders from attending physicians or residents before withdrawing the medications, lengthening the child's stay in the hospital.
The average length of stay for children brought to the hospital with asthma attacks is about three days, Johnson said, so a reduction of 13.5 hours results in substantial savings of time and money. The Hopkins team attributes the difference principally to the requirement that nurses in the control group waited for physicians' orders to stop the medication, while nurses in the experimental group had more autonomy.
"Because there are far more nurses than physicians watching children on a regular basis, nurses know the near-exact moment when children are better and can be weaned to less frequent nebulized therapy," Johnson says.
To check the safety and effectiveness of the two treatment approaches, Johnson conducted three follow-up interviews with parents one day, one week and two weeks after release from the Hopkins Children's Center and found no significant difference in hospital revisits. "This suggests there were no adverse effects on the children's health during the first two weeks attributable to the earlier discharge," Johnson says. "Beyond the second week, differences in the manner and frequency with which asthma drugs are used at home make a controlled study impossible."
Nationwide, an estimated $1 billion a year is spent on hospitalizing young asthmatics. Reductions in unnecessary medication for children throughout the United States could translate into a savings of millions of dollars in health care costs.
Support for the study came from funds donated to the 1998 Children's Miracle Network Telethon. Co-authors of the journal report were Carol Blaisdell, M.D., Allen Walker, M.D., and Peyton Eggleston, M.D.