Children admitted with asthma leave hospital sooner, thanks to new study

Having patients leave the hospital as soon as safely possible is a primary goal of all health care professionals. A new study led by Dr. Catherine Pound, a pediatrician at the Children’s Hospital of Eastern Ontario (CHEO) and assistant professor at the University of Ottawa, has led to an 18% decrease in length of stay for children admitted to the hospital with severe asthma. In short, CHEO research makes a measurable impact on asthma care, as published today in Hospital Pediatrics.

When a child with severe asthma symptoms is admitted to CHEO, they are typically placed on Ventolin, a medication that relaxes muscles in the airways and increases airflow to the lungs. While nurses are responsible for monitoring these children, physicians are in charge of weaning children off the medication to the point that they are discharged from the hospital. This can lead to delays in weaning children from medication, and ultimately in being discharged, if physicians are busy with higher priority cases.  

CHEO resident Dr. Victoria Gelt noticed the current process was resulting in longer hospital stays for some patients, and came forward with a suggestion that the nurses, who were already responsible for noting the signs of when a child should be weaned, be given more control in the process. Together, Drs. Pound and Gelt worked with CHEO respirologist and University of Ottawa professor Dr. Tom Kovesi, to develop and test a protocol for an innovative randomized controlled study.

Key Study Facts

113 study participants (children at CHEO) were recruited between May 2012 and September 2015

Over a two-year period, nurses were trained on the Pediatric Respiratory Assessment Measure (PRAM) score, an evidence-based tool designed to assess asthma

PRAM scores involve assessing measurable and objective markers like the patient’s breathing, seeing if they are using accessory muscles (those that aren’t typically used for breathing), using stethoscopes to listen to the patient’s lungs, the rapidity of their breathing, and their oxygen saturation

Post study analysis showed an 18% reduction in the length of stay, when nurses were in charge of weaning the Ventolin

Nurses monitor the child during their stay and adjust their Ventolin as required based on the PRAM score. Once they have weaned the child down to two puffs every four hours, the child is ready to go home. At that point, a physician is called to sign the discharge papers for each patient. CHEO leadership recognized the numerous benefits of this new process, and have already implemented the changes within the hospital.

Dr. Catherine Pound, CHEO Pediatrician and assistant professor at the University of Ottawa, said:

“The nurses were already observing the children and then calling the doctors to say that the child was ready. That’s why I thought it was such a great idea, if we could give that power to the nurses then they don’t need to call us anymore. One of the biggest considerations that went into the study was safety. We found that there was absolutely no difference in terms of safety, whether a nurse or physician was weaning the child. Now we have a way to assess inpatient asthma in an objective, measurable way.”

The University of Ottawa—A crossroads of cultures and ideas

The University of Ottawa is home to over 50,000 students, faculty and staff, who live, work and study in both French and English. Our campus is a crossroads of cultures and ideas, where bold minds come together to inspire game-changing ideas. We are one of Canada’s top 10 research universities—our professors and researchers explore new approaches to today’s challenges. One of a handful of Canadian universities ranked among the top 200 in the world, we attract exceptional thinkers and welcome diverse perspectives from across the globe.

About the CHEO Research Institute

The CHEO Research Institute coordinates the research activities of the Children’s Hospital of Eastern Ontario (CHEO) and is affiliated with the University of Ottawa. Its three programs of research include molecular biomedicine, health information technology, and evidence to practice research. Key themes include cancer, diabetes, obesity, mental health, emergency medicine, musculoskeletal health, electronic health information and privacy, and genetics of rare disease. The CHEO Research Institute makes discoveries today for healthier kids tomorrow. For more information, visit CHEO or @CHEOhospital.

​​Media contact:

Amélie Ferron-Craig
Media Relations Officer
University of Ottawa
Cell: 613-863-7221
aferronc@uOttawa.ca