Background Analysis & Limitations Summary Sample Methods Data Collection & Outcomes Purpose...
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Background
Analysis & Limitations
Summary
Sample
Methods Data Collection & Outcomes
Purpose
Pediatric assessment triangle (PAT) is a simple, rapid, and accurate assessment tool supported by
the American College of Emergency Physicians and the American Academy of Pediatrics. Currently,
it is utilized in Pediatric advanced life support courses (PALS) (Horeczko & Gausche-Hill, 2010).
The PAT will be used as a primary triage tool for pediatric patients with asthma exacerbations, to
measure the time from triage to first pharmacological treatment. This pilot study aims to decrease
time from triage to first treatment, identify patients who are emergent vs. non-urgent, improve
accuracy and consistency inn pediatric triage for patients with asthma, prevent complications of
asthma exacerbations and improve overall successful outcomes.The study also aims to improve
negative outcomes with pediatric asthma patients such as patient intubation, prolonged hospital
stays, and increased cost for hospitals.
• According to the CDC, asthma in pediatric patients is on the rise (CDC, 2015).
• Children with asthma entering the Emergency Department (ED) for asthma exacerbations are not
receiving asthma treatment in an adequate amount of time causing the asthma exacerbation to be
much worse than necessary (O’Connor, Saville, Hartert, & Arnold, 2014; Bekmezian, 2013).
• General emergency departments may not be knowledgeable in triaging pediatric asthma patients
(Lugo & Pavlicich, 2013).
• Even though many studies have shown that clinical pathways for asthma management improve
adherence to evidence-based management, improve patient outcomes, reduce cost in EDs, and
reduce hospitalization, there are still general hospital ED’s without systematic guidelines to triage
pediatric patients (Lougheed & Olajos-Clow, 2010).
• General emergency departments may improve time to first treatment by adopting a standardized
clinical guideline for dealing with pediatric asthma patients.
Design: Six month Prospective Observational Pilot Study
Location: Non-Pediatric Hospital Emergency Department
Target Population: Pediatric patients with asthma exacerbation, newly or previously diagnosed
Independent Variable (IV) 1: Usual Care + PAT tool
1. PAT Tool: Assessment tool used to assess pediatric airway status
2. Usual Care: This includes the nurses prior training, education, experience, and intuition when
triaging patients within the ED.
IV 2: Usual Care (control)
DV: Time from triage to first pharmacological treatment
Prior to Study
3. IRB Approval: Informed Consent Waiver for PAT Protocol
a. Data to be collected: age, diagnosis during visit, past medical history, whether PAT tool
was used or not, the findings from the PAT tool, time of triage, time of first
pharmacological treatment.
4. Education and training:
a. Nurses will be formally trained in PAT tool use with a multimedia lecture in 4 - 1 hour
sessions; to be completed during team meetings (Utilizing simulations and lecture)
Data Collection
1. At the end of the six month study period, we will review the medical records of pediatric
asthma patients that were both triaged with the use of the PAT tool and those triaged without
the use of the PAT tool.
a. EMR will have reminder for weeks to use PAT, as well as checklist that the RN will fill
out to be sure they used the triage tool.
2. We will collect data on those patients that are inclusive to the study.
3. The data will be: age, diagnosis during visit, past medical history, whether PAT tool was used
or not, the findings from the PAT tool, time of triage, time of first treatment.
4. Our data to be analyzed will focus on the time from triage to time to first treatment.
5. The data will be collected in minutes and seconds.
Outcomes and Measures
6. The mean between the time of triage to first nebulization treatment using the PAT tool
compared to the time of triage to first treatment, without using the PAT tool.
7. Unpaired two sample t-test was chosen because the sample groups are statistically different
from one another and can be studied independently using the collected quantitative data.
8. Additional analysis for missing data, will be conducted.
Sample Size: n = 500
1. Inclusion Criteria
a. Pediatric asthma exacerbation, newly or previously diagnosed
2. Exclusion Criteria
a. Emergency transport to the emergency department
b. Cystic fibrosis
c. Bronchiolectasis
d. Tracheostomies
e. congenital respiratory anomalies
f. Tuberculosis
g. Lung transplant
h. Chronic lung disease
i. Continuous oxygen use
j. Temperature >100.4 F indicating underlying infection such as
pneumonia
k. Any other underlying chronic respiratory illnesses that would
expedite the patient to receive treatment or alter the triage level
assigned
*The PAT tool will be used at one emergency department to assess the use
of the tools effectiveness on time of triage to first pharmacological treatment
*Decreasing the time of triage to first treatment will improve overall patient
outcome by providing more timely care to patients suffering from
exacerbation
*The PAT tool will be implemented to other emergency departments and
used as a universal measurement to assess pediatric asthmatic exacerbation
once proven effective
*The PAT tool will improve the quality of care provided by healthcare
professionals due to its uniformity throughout all emergency department
settings.
*implications for nursing practice-what will these interventions mean for
nursing practice?
Research Question
1) “In pediatric asthma patients with acute exacerbation, will the use of the Pediatric Assessment
Triangle (PAT) tool decrease time to first pharmacological treatment compared to no use of
the PAT tool, during their visit to a non-pediatric ED?”
2) Hypothesis: The PAT tool will decrease the time from triage to first pharmacological treatment
in pediatric asthma patients with acute exacerbation of asthma.
Decreasing time to first treatment for pediatric asthma exacerbations using the PAT triage tool: A feasibility study Kristen Badawy, Andrew Bierman, Laura Champion, Kirstee Novak, Erin Stiefel
Azusa Pacific University, San Diego, CA
Analysis
•Unpaired two sample t-test was chosen because the sample groups are
statistically different from one another and can be studied independently
using the collected quantitative data
•A data analytic plan will be in place
Limitations
1. Pilot study is unable to be generalized due to small sample size and
reliance of nurses utilizing PAT tool accurately
2. PAT tool is intuitive it is hard to quantify insure consistency
3. Missing data cannot be generalized due to small non-randomized
sample size Methods (Cont’d)
Study Design: Each IV will be implemented on a weekly basis; alternating weeks for a total of 12
weeks of PAT and 12 weeks of just usual care.
1. Week 1: Usual care + PAT
2. Week 2: Usual care only
a. Weeks will start on Sundays at a shift break (depending on the hospital); researchers
will be onsite at new week start to ensure use of or no use of PAT tool is implemented
b. Charge nurse will remind the nurses to use the PAT or not
c. Charge nurse will place a sign that signifies to use PAT, within the triage area
3. Triage nurses will be responsible for documenting the use of the tool, findings from the use of
the tool, and time the triage occurred.
a. Hospitals with computer charting will add a checkbox in system
b. Hospitals with paper charting will use a form with PAT usage question
4. At least twice per week, visit to the emergency department will help to ensure compliance.
a. Review patient charts and pertinent data for consistency and compliance.
b. Follow up with staff to see if any questions can be answered or if further education is
necessary.
References
Asthma & Children Fact Sheet- American Lung Association. (2014, September 1).Retrieved June 09, 2015, from http://www.lung.org/lung-disease/asthma/resources/facts-and-figures/asthma-children-fact-sheet.html
Bekmezian, A., Fee, C., Bekmezian, S., Maselli, J., & Weber, E. (2013). Emergency department crowding and younger age are associated with delayed corticosteroid administration to children with acute asthma. Pediatric Emergency
Care, 10. doi:10.1097/PEC.0b013e3182a5cbde
Dexheimer, J. W., Abramo, T. J., Arnold, D. H., Johnson, K. B., Shyr, Y.,Ye, F., & Aronsky, D. (2013). An asthma management system in a pediatric emergency department. International Journal Of Medical Informatics, 82230-238.
doi:10.1016/j.ijmedinf.2012.11.006
Dieckmann, R., Brownstein, D., & Gausche-Hill, M. (n.d). The Pediatric Assessment Triangle A Novel Approach for the Rapid Evaluation of Children. Pediatric Emergency Care, 26(4), 312-315.
Doyle, S. L., Kingsnorth, J., Guzzetta, C. E., Jahnke, S. A., McKenna, J. C., & Brown, K. (2012). Research: Outcomes of Implementing Rapid Triage in the Pediatric Emergency Department. Journal Of Emergency Nursing, 3830-35.
doi:10.1016/j.jen.2010.08.013
Lougheed, M. D., & Olajos-Clow, J. G. (2010). Asthma care pathways in the emergency department. Current Opinion in Allergy and Clinical Immunology. doi:10.1097/ACI.0b013e328339731d
Lugo, S. E., & Pavlicich, V. (2013). Quality in triage: indicators in patients with respiratory disease. Pediatric Emergency Care, 29(6), 710-714.
O'Connor, M. G., Saville, B. R., Hartert, T. V., & Arnold, D. H. (n.d.). Treatment Variability of Asthma Exacerbations in a Pediatric Emergency Department Using a Severity-Based Management Protocol. Journal of Clinical Pediatrics,
53(13), 1288-1290. doi:10.1177/0009922813520071
Qazi, K., Altamimi, S., Tamim, H., Serrano, K., & Riyadh, S. (2010). Impact of an emergency nurse-initiated asthma management protocol on door-to-first-salbutamol-nebulization-time in a pediatric emergency department. Journal of
Emergency Medicine, 36(5), 428-433. 10.1016/j.jen.2009.11.003.