When a child with asthma struggles to breathe it can be very frightening for both the child and the parent. Intermountain Children’s Health has created a new pediatric asthma initiative to provide treatment in a more consistent and timely manner closer to home. 

“This is based on some work that we did in 2015,” said Mike Johnson, MD, a pediatrician in the emergency department at Intermountain Primary Children’s Hospital and asthma advocate. “It was almost 10 years ago when at the Primary Children’s Hospital emergency department we realized we were hospitalizing more children than other pediatric hospitals were and we started to look at why that was.”

Johnson said they realized that they had a lot of barriers to really doing the right things for kids. “We were really delaying the care that we were delivering. So we created a process that would allow us to just find the kids that needed treatment as soon as they arrived and get that treatment to them with fewer obstacles to slowing it down and we reduced the number of children we hospitalized by about a third.”

In an emergency department as providers it was a big change, he said. “You can imagine that’s really rewarding if we're able to be more efficient, we're able to deliver care better. It was less frustrating for us.”

For parents and families it’s a huge thing to be able to come to the hospital, get treatment and have their child feeling better and not have to stay in the hospital, said Johnson. “Intermountain Health really started to expand a little bit to other hospitals and then created a bigger role for children's health, kind of the children’s arm of Intermountain Health, to play a bigger role across the system.”

Johnson said Intermountain Health wanted to make sure the process that it had would work for all the other emergency departments. “We always intended that this would be something that any emergency department could do.”

There’s some kind of division of labor when someone comes into the ER, he said. “Somebody – usually a nurse – will be the first person to talk to you about what’s happening with you or your child. That triage nurse has some ability to start some treatment right away even without a doctor seeing a person.”

For example a broken bone, said Johnson. “They can give you some pain medicine. If you have something that needs a specific test they can order that. That was really one of the main components of what made our work successful was giving those nurses more latitude within their scope of practice to start treatment when it was appropriate.”

So that means identifying kids that have asthma who are showing up to the ER and identifying which children are really sick enough to need really intensive treatment from the very start, he said. “Then giving them that treatment without having to have a doctor to sign off on all of that because usually the doctors are the things that are in shortest supply in the ER.”

Johnson said Intermountain Health called out a standing order. “We’ve organized this so that any hospital now has all the resources they need to have local approvals so that they have their nurses in the ER who can start all the treatment with the standing order.”

So with asthma that means a couple of specific medicines, he said. “That means starting a steroid medicine that is very, very effective but it takes a little while to work and starting some breathing treatments with medicines that work right away but tend to wear off within a few hours.”

It’s important that those are all started all at once, said Johnson. “So we treat the symptoms right away and give time for those other medicines to work well. So we’re doing a push, incorporating that into education this summer and into fall, hoping that we see some results.”

Hopefully there will be some improvement in the number of kids that are in the hospital after they come to the ER, he said. “We’re trying to make it easier with this to make that big change a little simpler. To change the way that the process is managed so it’s more in line with the processes that you are already using where it is part of the nurse’ normal workflow when they’re screening kids that they can start this treatment and not rely as much on an individual doctor needing to make that decision which again, is a slow way to do this.”

The treatment protocol is also being used by first responders such as South Davis Metro Fire. “We were contacted by Primary Children’s Medical Center about a study they were going to start regarding RSV and asthma and steroid administration in the pre-hospital setting," said South Davis Metro Fire Chief Jeff Larsen. “We jumped in one hundred percent to work with them. We have a lot of pediatric patients and the population is big in the south end of Davis County.” 

Larsen said they carry it (steroids) when they go out on calls. “We’ve been trained on it and we’re aware of it. We’re always accessible 24/7 and we have a rapid response time. We’re always willing to come and take care of patients. Anytime you have a pediatric patient that is suffering from some sort of respiratory emergency it’s emergent.”

The good thing about this Larsen said is when they encounter them the protocols are in place. “This just helps supplement the protocol that we already have issued by the state. This gives us one more tool.”