Having patients leave the hospital as soon as safely possible is a primary goal of all health care professionals. A new study led by Dr. Catherine Pound, a pediatrician at the Children’s Hospital of Eastern Ontario (CHEO) and assistant professor at the University of Ottawa, has led to an 18% decrease in length of stay for children admitted to the hospital with severe asthma. In short, CHEO research makes a measurable impact on asthma care, as published in the journal Hospital Pediatrics.

When a child with severe asthma symptoms is admitted to CHEO, they are typically placed on Ventolin, a medication that relaxes muscles in the airways and increases airflow to the lungs. While nurses are responsible for monitoring these children, physicians are in charge of weaning children off the medication to the point that they are discharged from the hospital. This can lead to delays in weaning children from medication, and ultimately in being discharged, if physicians are busy with higher priority cases.

CHEO resident Dr. Victoria Gelt noticed the current process was resulting in longer hospital stays for some patients, and came forward with a suggestion that the nurses, who were already responsible for noting the signs of when a child should be weaned, be given more control in the process. Together, Drs. Pound and Gelt worked with CHEO respirologist and University of Ottawa professor Dr. Tom Kovesi, to develop and test a protocol for an innovative randomized controlled study.

Key Study Facts

• 113 study participants (children at CHEO) were recruited between May 2012 and September 2015
• Over a two–year period, nurses were trained on the Pediatric Respiratory Assessment Measure (PRAM) score, an evidence–based tool designed to assess asthma
• PRAM scores involve assessing measurable and objective markers like the patient’s breathing, seeing if they are using accessory muscles (those that aren’t typically used for breathing), using stethoscopes to listen to the patient’s lungs, the rapidity of their breathing, and their oxygen saturation
• Post study analysis showed an 18% reduction in the length of stay, when nurses were in charge of weaning the Ventolin

Nurses monitor the child during their stay and adjust their Ventolin as required based on the PRAM score. Once they have weaned the child down to two puffs every four hours, the child is ready to go home. At that point, a physician is called to sign the discharge papers for each patient. CHEO leadership recognized the numerous benefits of this new process, and have already implemented the changes within the hospital.

Dr. Catherine Pound, CHEO Pediatrician and assistant professor at the University of Ottawa, said: “The nurses were already observing the children and then calling the doctors to say that the child was ready. That’s why I thought it was such a great idea, if we could give that power to the nurses then they don’t need to call us anymore. One of the biggest considerations that went into the study was safety. We found that there was absolutely no difference in terms of safety, whether a nurse or physician was weaning the child. Now we have a way to assess inpatient asthma in an objective, measurable way.”