WIP 35 - Quality improvement project focusing on improving outcomes and outpatient follow-up in pediatric asthma patients

Publication Number: WIP 35.7616

Alexandra Shade Silver, SUNY Downstate Medical Center, Brooklyn, NY, United States; Midhat Khan, State University of New York Downstate Medical Center College of Medicine, Brooklyn, NY, United States; Samyuktha Sivakumar, SUNY Downstate Health Sciences University/ Kings County Hospital Center, Brooklyn, NY, United States; Marie-Stella Uwamahoro, State University of New York Downstate Medical Center College of Medicine, Brooklyn, NY, United States; Daniela Santos Bueno, Suny downstate, Brooklyn, NY, United States; Isabella Corredor, State University of New York Downstate Medical Center College of Medicine, Brooklyn, NY, United States; Lauren Rothe, SUNY Downstate Health Sciences University, Brooklyn, NY, United States; Diana E. Weaver, State University of New York Downstate Medical Center College of Medicine, Brooklyn, NY, United States; Ratna B Basak, Kings County Hospitsl, Brooklyn, NY, United States

Background: Asthma is a common inflammatory condition of the airways that leads to recurrent episodes of chest tightness, breathlessness, and wheezing. It is a significant cause of morbidity and mortality. In the United States, nearly 60% of children with asthma experience exacerbations annually, with approximately 20% requiring emergency department (ED) visits and 3% requiring inpatient admissions. It has been shown that providing early follow up visits after discharge improves asthma control, reduces the risk of asthma-related ED visits, and hospital readmission.

Objective: The aim of this study is to improve the asthma clinic follow up of discharged patients that were admitted for asthma exacerbations from 50% to 80% in 6 months at Kings County Hospital.

Design/Methods: The inclusion criteria included children aged 2-21 years of age with a primary diagnosis of asthma admitted to the Kings County Pediatric Floor and Pediatric Intensive Care Unit. Baseline data was collected from October 2023 to August 2024 by reviewing the charts of discharged patients to see if they went for a follow up visit in the asthma clinic within 1 month of the discharge. The study was submitted for IRB approval.

A series of interventions with Plan-Do-Study-Act (PDSA) that focussed on increasing the follow-up and decreasing the no show rate in the asthma clinics. The first PDSA cycle, that started in September 2024, focused on improving appointments scheduled within one month of discharge. All discharged patients were seen by a member of the asthma clinic team prior to discharge to establish rapport and appointments were scheduled. In the second cycle, that began in October, the inpatient teams were notified, and a poster was placed in both the pediatric inpatient unit and the PICU workrooms as a reminder. The third cycle, that started in November focused on improving appointment compliance. The asthma clinic scheduler will provide reminder phone calls 7 days before and 2 days before the appointment date.

All data should be collected by February 2025. This is a quality improvement in progress.