1. Home>
2. Specialties>
3. General Medicine>
4. Summary and Comment

A Clinical Pathway for Pediatric Asthma

Clinical pathways (also known as critical pathways) are multidisciplinary prescriptive approaches to the care of patients with specific diseases. Baltimore investigators randomized 110 hospitalized children (age range, 2 to 18), who presented with asthma exacerbations, either to standard care or to care using a clinical pathway. Key features of the pathway included a nurse-driven protocol for weaning patients from bronchodilators, and peak flow measurement before and after every nebulization.

Children cared for using the clinical pathway were significantly more likely to be discharged within 24 hours than were children who received standard care (38 percent vs. 15 percent). Compared with their standard-care counterparts, children who were cared for using the clinical path also received smaller doses of beta-agonists at every dosing interval. During the 2 weeks after discharge, no child in either group was admitted to the hospital. Three children in the control group had unscheduled visits for asthma symptoms.

Comment: This quality improvement project was well designed (featuring a randomized, controlled trial), and the results demonstrated that a clinical path can improve the care of hospitalized children with asthma. Along with computerized order entry (see JW Nov 15 2000, p. 174, accession number 001024001, and Arch Intern Med 2000; 160:2741), clinical pathways are coming to a hospital near you.

— H Bauchner

Published in Journal Watch General Medicine November 24, 2000

Citation(s):

Johnson K et al. Effectiveness of a clinical pathway for inpatient asthma management. Pediatrics 2000 Nov 106 1006 -1012.

• Original article (Subscription may be required)
• Medline abstract (Free)