About the Project
According to Child Health BC, asthma is the most common paediatric condition and cause of school absenteeism. The use of a validated and standardized clinical score for asthma has been associated with lower hospitalization rates and improved use of asthma medication (). Pediatrician Dr. Marie-Noelle Trottier-Boucher and her colleagues in nursing, respiratory therapy, pharmacy, respirology and paediatrics wanted to lower patients’ length of stay in the hospital for asthma. They aimed to do this mostly using an asthma discharge checklist, an admission order set and a clinical pathway in which inhaled bronchodilator therapy frequency was nurse lead and based on the PRAM (Paediatric Respiratory Assessment Measure, an objective scoring system that helps assess asthma severity). Their goal: giving themselves a one year timeframe, they aimed to lower the length of stay of children hospitalized for asthma exacerbation at Victoria General Hospital by 10%, to less than 48 hours.
To tackle this goal, they initiated a series of PDSA cycles – Plan, Do, Study, Act – enabling them to test interventions, see what worked, and make the necessary adjustments before trying again. They drew on existing resources, such as a well-established guide from Child Health BC and BC Children’s Hospital, and modified it based on local clinician feedback about what was needed in the Victoria context. Along the way, they found strong allies for this work, most notably the nursing staff. Nurses found using the PRAM score to calibrate asthma treatment brought additional, welcome responsibilities in the care of these patients, and strongly supported the initiative throughout. When it came time to survey parents about the educational resources that accompanied this intervention, the team drew on the insights of their patient partner, Laura Jane Brakefield.
While data analysis is still underway, initial analysis may suggest the team has met their goal of reducing median length of stay. Their Clinical Order Set is also in the process of being finalized.
When asked what the team would like to tackle next, Dr. Trottier-Boucher responds “Being able to spread this initiative up the Island would be our next goal”.
We congratulate the team: Jessica Kohli, Melissa Holland, Kyle Colins, Tracey Ramsey, Dr. Patrick McKernan, Dr. Raphael Beck, Dr. Jennifer Balfour, Dr Gaby Yang, Heather John, Michelle Brunelle, Emma Carrick, Laura Jane Brakefield, and Dr. Marie-Noelle Trottier-Boucher for this achievement!
 (1) Child Health BC. Provincial Asthma Guideline; Initial Management of Pediatric Asthma in Emergent/Urgent Care Settings. Vancouver, BC: Child Health BC, April 2018