Albuterol Shortage Patient Impact in a Pediatric Emergency Setting

Abstract

Background:

Asthma is one of the leading causes of hospitalization for pediatric patients, which routinely requires the use of albuterol in the course of emergency treatment. A national backorder of albuterol resulting in supply chain challenges occurred in 2022 (Figure 1). An interdisciplinary team of respiratory therapists, providers, and pharmacists partnered to develop countermeasures to reduce impact to our patients during the supply shortage and ensured product was available when needed. This included using 0.5 mL ampules to make large quantity syringes (4-20 mL) for continuous delivery, transitioning 0.5 mL treatments delivered via nebulizer to 90 µg pMDI via spacer, utilizing Xopenex for patients with home use and cardiac history as a front-line drug, and removing nebulized albuterol from our asthma pathways in the ED for mild and moderate asthma patients. We aimed to assess the impact of necessary albuterol management modifications had on ED LOS, hospital admission rate, and ICU admission rate in this pediatric asthma patients.

Methods:

In an IRB approved retrospective analysis data was collected and reviewed as part of standard operations in the EMR and reporting workbenches. The emergency department cared for 480 pediatric asthma patients from 10/15/2022 to 1/23/2023 (prior to change from nebulizers to pMDIs) and 480 pediatric asthma patients from 1/24/2023 to 5/22/2023 (after change from nebulizers to pMDIs). We reviewed the average ED LOS, admission rate, and ICU admission rates in the pre (10/15/2022-1/23/2023) and post (1/24/2023-5/22/2023) assessment periods.

Results:

In the pre assessment period (n = 480) average LOS was 7 hours 34 min (454 min). Of these 480 patients, 145 were admitted, with 14 needing ICU-level care. In the 480 patient encounters in the post assessment period, the LOS was 6 hours 34 min (394 min) (P < .01), 153 were admitted (P = .57), and 19 patients required ICU-level care (P = .37). Details are shown in Figure 2.

Conclusions:

Switching from 0.5 mL albuterol ampules to 90 µg pMDIs had no significant impact on patient admission rates or ICU-level care needed for mild and moderate pediatric patients reporting to the emergency room. LOS was significantly reduced in this patient population with the initiation of pMDIs over nebulized treatments. More research is needed related to cost and time implications of albuterol delivery methods.

Figure 1 details the original SBAR communciation sent to interdisciplinary teams to notify them of the liquid albuterol shortage.

Figure 2 details the length of stay, admision rate, and ICU admission rate for mild and moderate pediatric ED patients in the pre and post assessment period.