Clinical Pathway for Childhood Asthma in an Emergency Department: Comparison Between the Correct Versus Incorrect Application Groups

Nam, Ji Sun; Cho, Yeon Soo; Chun, Yoon Hong; Yoon, Jong seo; Kim, Hyun Hee; Kim, Jin Tack; Lee, Joon Sung

Abstract

PURPOSE
This study aimed to determine whether the standard clinical pathway based on evidence is applicable to pediatric asthma patients in the emergency room, and whether it is better for treatment effectiveness.
METHODS
The clinical pathway was applied to children who visited our emergency room due to acute asthma between January 1 and December 31, 2009. Medical records of the emergency room were reviewed to see if the clinical pathway was correctly applied. The patients were divided into 2 groups: those who the pathway was correctly applied and those who the pathway was incorrectly applied to (group B, n=41).
RESULTS
Acute asthma exacerbation occurred in 24 children (47%) in group A, while it occurred in 27 children (53%) in group B. The majority of patients in group B had moderate asthma exacerbation. The incorrect application of the clinical pathway and no use or insufficient use of inhaled anticholinergics was most frequently noted. The most common cause for the incorrect application of the clinical pathway was its misunderstanding of residents. The hospitalization rate was higher in group B than in group A.
CONCLUSION
The application of the clinical pathway to pediatric asthma patients in the emergency room increased treatment effectiveness. However, training for the residents and intensive care for the patient with moderate asthma exacerbation are necessary for correct application of the clinical pathway.