390

Abstract

Introduction: Standardized Clinical Assessment and Management Plans (SCAMPs) have been shown to be effective in decreasing variation in clinical practice in children. However, the effects of a SCAMP on the variation of care and on clinical outcomes in children with critical asthma are unknown. Methods: An asthma severity score triggered SCAMP for CAN and Helium-Oxygen driven CAN (Heliox-CAN) was developed to guide step-wise escalation and weaning of asthma therapies. The SCAMP guided therapy until albuterol was weaned to an intermittent frequency of q2hrs. All children ≥ 2 years of age admitted to a step-up unit and an ICU requiring CAN were managed via the SCAMP. The incidence of diversion from the SCAMP algorithm, defined as any single diversion, was recorded. The time to q2hr from initiation of CAN was compared between pre-SCAMP to post-SCAMP patients using the Mann-Whitney test with p<0.05 as statistically significant, and via statistical process control (SPC) chart to assess for special cause variation and reduction in variation of outcomes. The rate for escalation of care, need to restart CAN, and adverse effects were also determined. Results: There were 150 pre-SCAMP and 125 post-SCAMP patients eligible for analysis. Compliance with the SCAMP was a 68%. Heliox-CAN was applied in 42% of the cases when the patient did not improve with CAN alone per the SCAMP algorithm. There was a significant decrease in median time to q2hr by 5.8 hours after the initiation of the SCAMP (pre-SCAMP 20.5 hours (IQ 13.7, 30.7) to post-SCAMP 14.7 hours (IQ 8.3, 23.9), p<0.0001). SPC analysis showed that after the implementation of the SCAMP, there was a significant decrease in the variation in time to q2hr meeting special cause variation at week 16. Only 12% of patients required escalation of care, 9% required restarting CAN after initial wean to intermittent nebulization, and only one patient with a history of ectopic atrial tachycardia developed an arrhythmia. Conclusions: A Critical Asthma SCAMP, guided by an asthma severity score, was a safe and effective method to improve clinical outcomes and decreased time of critical care management.