A Pediatric Asthma Unit Staffed by Respiratory Therapists Demonstrates Positive Clinical and Financial Outcomes

Abstract

Background

We sought to determine the effects of an Asthma Care Unit (ACU), staffed primarily by respiratory therapists (RTs), on length of stay (LOS), hospital cost, charges to payers, care path variances and postdischarge outcomes for children admitted to our hospital.

Methods

From Sept 1, 1996-Apr 30, 1997, patients were admitted to the ACU. A control group was compiled from multiple patient units staffed primarily by registered nurses (RNs), using asthma care path (ACP) data from Oct 1, 1995-Aug 31, 1996. AU patients were treated for asthma by the same protocol. Patients admitted to the pediatric intensive care unit were excluded from both study groups. Deviations from the care path protocol were tracked for each patient. All asthma patients were followed up with a telephone survey to monitor postdischarge morbidity.

Results

Mean values (standard deviations, SD) for LOS, care path variances, hospital cost/case, and patient charges/case were compared using unpaired Student's t tests. Outcome variables showed a significant difference: LOS [ACU = 1.78 (0.75) d and Control= 2.04 (0.85) d; p = 0.0003]; care path duration [ACU = 1.41 (0.66) d and Control= 1.75 (0.72) d; p = 0.028]; care path variances [ACU = 2.7 (2.5) and Control= 9.4 (5.3); p < 0.0001]; hospital cost/case [ACU = $1,375 ($600) and Control= $1,522 ($750); p = 0.023]; and patient charges/case [ACU = $2,447 ($1,079) and Control = $2,732 ($1,319); p = 0.025]. Mean values (SD) for functional morbidity outcomes showed no increase in symptomatic days [ACU = 4.9 (7.7) and Control= 5.6 (7.2); p = 0.346] or parent workdays missed [ACU = 3.9 (3.1) and Control= 3.3 (3.6); p = 0.358]. However, there was a significant difference in school days missed [ACU = 5.3 (3.6) and Control= 3.8 (4.5); p = 0.026].

Conclusion

An ACU staffed by RTs was associated with a reduced LOS and care path variances and lower costs of care compared to standard treatment by RNs. These outcomes were realized with no increase in postdischarge functional morbidity. Average cost savings/case was $150. Estimated hospital cost savings/year at this hospital is $135,000. An additional $170,000 could be saved in the conversion of full-time RNs to RTs and patient care assistants.