Asthma: Reducing Hospital Readmissions

Nemours' Top-Notch Asthma Plan of Care

As experts in asthma care, at Nemours we know that the condition is the No. 1 reason why kids miss school and visit hospital emergency departments each year. At Nemours/Alfred I. duPont Hospital for Children, our goal is to provide the treatment and guidance both you and your child need to successfully manage the disease and avoid asthma emergencies.

Part of that goal is offering top-notch preventive care and education, making sure that if children do have to be hospitalized for asthma that they don’t need to be admitted to the hospital again within a certain time frame (this is called “readmission”). That means we send families home with the tools and knowledge they need to keep kids from having additional, often preventable asthma attacks. And we track how we’re doing by looking at the number of kids who are readmitted for asthma within 7 days (a week) or 30 days (a month) after they stayed with us overnight.

What we’ve found: Very, very few of the children with asthma who are admitted here end up coming back again within a week; just two children were readmitted within 7 days in 2008 and eight in 2009 (a year when many hospitals saw an increase in asthma hospital admissions and readmissions because of the H1N1 flu virus).

And, over time, we’re getting better and better at keeping our asthma readmissions down. From 2007 to 2009, less than 1% (.91%, to be exact) of our asthma patients had to come back to the hospital overnight within a week after being admitted. By the first half of 2010, we had absolutely no readmissions, versus the .31% national average of other children’s hospitals.

We’re also proud to say that in the first half of 2010 we were able to keep our asthma readmission rates almost nonexistent at both 1 week and 1 month. From January through June 2010 we had zero readmissions within 7 days and only one within 30 days.

Plus, all of the children with asthma who are admitted to duPont Hospital for Children receive the nationally recommended medications for treatment of acute asthma (that is, “asthma flare-ups,” also known as “asthma attacks”). In fact, we help set the standards when it comes to asthma medicines: Nemours was instrumental in bringing this medication use into the national forefront as a guideline.

How We Do It

To keep kids from having to come back to the hospital, whether that means our emergency room or having to stay overnight, we put a lot of effort into encouraging an asthma “Plan of Care” after hospitalization.

Our asthma care team — pulmonologists, allergists, pediatricians, nurse practitioners, respiratory therapists, and nurses — adhere to evidence-based national standards for asthma management. For starters, each child gets a thorough assessment about their asthma symptoms and environmental triggers.

Every child, and their family, also receives comprehensive asthma education during the visit from a respiratory therapist. We make sure kids with asthma and their parents understand how:

• asthma affects the body
• to keep symptoms under control
• to manage triggers and symptoms
• asthma medicines work when used the right way (and regularly)

Plus, we ensure that children go home with the supplies that they need, like spacers and nebulizers. And we make sure that children are discharged only when both the treating team and the parent mutually agree that the child is stable enough for the condition to be managed at home.

To reduce or prevent asthma flare-ups and hospital visits, we strive to have each child discharged with a personalized, written “asthma action plan” (or “asthma management plan”) to keep your child healthy not just today, but every day.

Keeping Asthma in Check at Home

Of course, no matter where a child with asthma is treated or admitted, no health care professional or health system can prevent all asthma attacks from happening once the child is sent home. Although every parent and guardian whose child is hospitalized with us is given instructions on what to do after their child is released from the hospital, some may not stick to the plan after discharge.

In order to keep kids with asthma from experiencing asthma attacks, it’s always important to:

• Keep children with asthma out of daycare for the recommended 2 to 3 days after being discharged from the hospital.
• Fill and refill all prescription medications — including rescue and controller medicines — and use them exactly as directed.
• Stop smoking in the home, car, or anywhere around children with asthma.
• Keep children’s triggers in mind (like dust mites and pets) and try to reduce or eliminate their exposure as much as possible.

Sticking to your child’s asthma care plan and avoiding known triggers can help you take control of your child’s condition and keep it from getting worse. Whether your child is being taken care of at our hospital or at home, we’ll treat your child as we would our own and help your family do whatever it takes to avoid asthma emergencies.