November 20, 1998

Whether seen in Emergency or admitted to the Pediatric ICU or an inpatient floor, more children come to MGH with acute asthma than with any other chronic illness. A new pathway for pediatric asthma patients, developed under an OI initiative, not only streamlines care delivery, but also teaches children and their parents how to manage the disease, preventing the flare-ups that lead to repeated hospital visits.

"The pathway is like a map for care," says Mary Lou Kelleher, MS, RN, pediatric clinical nurse specialist and pathway manager. It provides a set of guidelines for the many clinicians – including respiratory therapists, physical therapists, nurses, physicians and pulmonologists – who treat pediatric patients with asthma.

The pathway includes a detailed evaluation of each child to better understand and treat his or her asthma. Children and parents are asked about family history, patterns of the disease and situations that cause attacks. Once the assessment is complete, families are given recommended treatments and medications.

Patient education is emphasized throughout the pathway. Children and parents receive a formal asthma education management session that is reinforced throughout the hospital stay. Given by a nurse or respiratory therapist, the session answers questions such as what asthma does to the lungs, what triggers asthma flare-ups and how to use peak-flow meters, medications, inhalers and other administration devices. Lifestyle issues, such as dealing with asthma in school, also are discussed.

To assess the pathway's effectiveness, the number of readmissions before and after its implementation will be compared. Kelleher expects that results will show a decrease in readmissions, indicating that the pathway has taught patients to manage their asthma better and, consequently, avoid trips to the hospital.

Ronald Kleinman, MD, chief of Pediatric Gastroenterology and Nutrition and associate chief of Pediatrics, says, "We're very pleased that this pathway provides a real opportunity for all those involved in the care of children with asthma to come together and provide a comprehensive approach to working with the patient and family and improving the outcomes of children affected by asthma."

Mary Lou Kelleher, MS, RN, teaches a young patients about asthma triggers.