PC1037: Reducing Time from Pediatric Emergency Department Arrival to Dexamethasone Administration in Wheezing Patients

Purpose/Objectives: Asthma exacerbations are common diagnosis among patients presenting to pediatric emergency departments (EDs). Standard treatment of moderate-to-severe exacerbations includes administration of oral corticosteroids in addition to bronchodilators. Early administration of corticosteroids decreases ED length of stay (LOS) and rates of hospitalization. Our SMART aim was to reduce the average time from patient arrival to dexamethasone administration in patients >2 years of age with an initial Pediatric Asthma Severity Score (PASS) > 6 from 60 to 30 minutes within six months.

Design/Methods: We utilized the Model for Improvement with collaboration between ED physicians and nursing, pharmacy, and respiratory therapy. Our multidisciplinary team reviewed baseline data and developed a key driver diagram (Figure 1). Initial interventions included nursing education, signs encouraging early ordering of dexamethasone in triage, rounding of dexamethasone dosing in the electronic medical record (EMR), supplying the triage area with 1mg dexamethasone tablets and a pill crusher, updates to an asthma standing order set for nursing, and pertinent chief complaints triggering nurses to document a PASS in the EMR with an automated alert recommending use of the asthma order set. Primary measure was the time from arrival to dexamethasone administration. Secondary measure was ED LOS for discharged patients. We used statistical process control to analyze changes in measures over time.

Results: From October 2021 to March 2022, the average time to dexamethasone administration decreased from 62 to 42 minutes (Figure 2). ED LOS for discharged asthma exacerbation patients did not change despite an overall rise in ED LOS for all discharged patients.

Conclusion/Discussion: Using QI methodology, we successfully decreased the time from ED arrival to administration of dexamethasone in asthma exacerbation patients from 62 to 42 minutes. Ongoing initiatives continue to be emphasized and new interventions implemented including installing a sink in triage, expansion of chief complaints that trigger PASS scoring in triage, and multidisciplinary education.