Evaluating the length of stay and value of time in a pediatric emergency department with two models by comparing two different albuterol delivery systems
Abstract Objective: Asthma is one of the most common childhood illnesses and accounts for a substantial amount of pediatric emergency department visits. Historically, acute exacerbations are treated with a beta agonist via nebulizer therapy (NEB). However, with the advent of the spacer, the medicati...
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| Veröffentlicht in: | Journal of medical economics 2012-08, Vol.15 (4), p.704-711 |
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| creator | Staggs, Lauren Peek, Meagan Southard, Gary Gracely, Ed Baxendale, Sidney Cross, Keith P. Kim, In K. |
| description | Abstract
Objective:
Asthma is one of the most common childhood illnesses and accounts for a substantial amount of pediatric emergency department visits. Historically, acute exacerbations are treated with a beta agonist via nebulizer therapy (NEB). However, with the advent of the spacer, the medication can be delivered via a metered dose inhaler (MDI + S) with the same efficacy for mild-to-moderate asthma exacerbations. To date, no study has been done to evaluate emergency department (ED) length of stay (LOS) and opportunity cost between nebulized vs MDI + S. The objective of this study was to compare ED LOS and associated opportunity cost among children who present with a mild asthma exacerbation according to the delivery mode of albuterol: MDI + S vs NEB.
Methods:
A structured, retrospective cross-sectional study was conducted. Medical records were reviewed from children aged 1-18 years treated at an urban pediatric ED from July 2007 to June 2008 with a discharge diagnosis International Classification of Disease-9 of asthma. Length of stay was defined: time from initial triage until the time of the guardian signature on the discharge instructions. An operational definition was used to define a mild asthma exacerbation; those patients requiring only one standard weight based albuterol treatment. Emergency department throughput time points, demographic data, treatment course, and delivery method of albuterol were recorded.
Results:
Three hundred and four patients were analyzed: 94 in the MDI + S group and 209 in the NEB group. Mean age in years for the MDI + S group was 9.57 vs 5.07 for the NEB group (p |
| doi_str_mv | 10.3111/13696998.2012.674587 |
| format | Article |
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Objective:
Asthma is one of the most common childhood illnesses and accounts for a substantial amount of pediatric emergency department visits. Historically, acute exacerbations are treated with a beta agonist via nebulizer therapy (NEB). However, with the advent of the spacer, the medication can be delivered via a metered dose inhaler (MDI + S) with the same efficacy for mild-to-moderate asthma exacerbations. To date, no study has been done to evaluate emergency department (ED) length of stay (LOS) and opportunity cost between nebulized vs MDI + S. The objective of this study was to compare ED LOS and associated opportunity cost among children who present with a mild asthma exacerbation according to the delivery mode of albuterol: MDI + S vs NEB.
Methods:
A structured, retrospective cross-sectional study was conducted. Medical records were reviewed from children aged 1-18 years treated at an urban pediatric ED from July 2007 to June 2008 with a discharge diagnosis International Classification of Disease-9 of asthma. Length of stay was defined: time from initial triage until the time of the guardian signature on the discharge instructions. An operational definition was used to define a mild asthma exacerbation; those patients requiring only one standard weight based albuterol treatment. Emergency department throughput time points, demographic data, treatment course, and delivery method of albuterol were recorded.
Results:
Three hundred and four patients were analyzed: 94 in the MDI + S group and 209 in the NEB group. Mean age in years for the MDI + S group was 9.57 vs 5.07 for the NEB group (p < 0.001). The percentage of patients that received oral corticosteroids was 39.4% in the MDI + S group vs 61.7% in the NEB group (p < 0.001). There was no difference between groups in: race, insurance status, gender, or chest radiographs. The mean ED LOS for patients in the MDI + S group was 170 minutes compared to 205 minutes in the NEB group. On average, there was a 25.1 minute time savings per patient in ED treatment time (p < 0.001; 95% CI = 3.8-31.7). Significant predictors of outcome for treatment time were chest radiograph, steroids, and treatment mode. Opportunity cost analysis estimated a potential cost savings of $213,532 annually using MDI + S vs NEB.
Conclusion:
In mild asthma exacerbations, administering albuterol via MDI + S decreases ED treatment time when compared to administering nebulized albuterol. A metered dose inhaler with spacer utilization may enhance opportunity cost savings and decrease the left without being seen population with improved throughput.
Limitations:
The key limitations of this study include its retrospective design, the proxy non-standard definition of mild asthma exacerbation, and the opportunity cost calculation, which may over-estimate the value of ED time saved based on ED volume.</description><identifier>ISSN: 1369-6998</identifier><identifier>EISSN: 1941-837X</identifier><identifier>DOI: 10.3111/13696998.2012.674587</identifier><identifier>PMID: 22400716</identifier><language>eng</language><publisher>England: Informa UK Ltd</publisher><subject>Adolescent ; Adrenergic beta-2 Receptor Agonists - administration & dosage ; Albuterol - administration & dosage ; Anti-asthmatic agents ; Asthma ; Asthma - drug therapy ; Child ; Child, Preschool ; Economics ; Emergency Service, Hospital ; Female ; Hospitals, Pediatric ; Humans ; Infant ; Kentucky ; Length of Stay - economics ; Male ; Medical Audit ; Medication therapy management ; Metered Dose Inhalers - economics ; Quality of healthcare disease management ; Regression Analysis ; Retrospective Studies</subject><ispartof>Journal of medical economics, 2012-08, Vol.15 (4), p.704-711</ispartof><rights>2012 Informa UK Ltd All rights reserved: reproduction in whole or part not permitted 2012</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3797-95cf2f422acd125e20636d09143a21578146ca76febeac7312810b50a4b6c6a13</citedby><cites>FETCH-LOGICAL-c3797-95cf2f422acd125e20636d09143a21578146ca76febeac7312810b50a4b6c6a13</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22400716$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Staggs, Lauren</creatorcontrib><creatorcontrib>Peek, Meagan</creatorcontrib><creatorcontrib>Southard, Gary</creatorcontrib><creatorcontrib>Gracely, Ed</creatorcontrib><creatorcontrib>Baxendale, Sidney</creatorcontrib><creatorcontrib>Cross, Keith P.</creatorcontrib><creatorcontrib>Kim, In K.</creatorcontrib><title>Evaluating the length of stay and value of time in a pediatric emergency department with two models by comparing two different albuterol delivery systems</title><title>Journal of medical economics</title><addtitle>J Med Econ</addtitle><description>Abstract
Objective:
Asthma is one of the most common childhood illnesses and accounts for a substantial amount of pediatric emergency department visits. Historically, acute exacerbations are treated with a beta agonist via nebulizer therapy (NEB). However, with the advent of the spacer, the medication can be delivered via a metered dose inhaler (MDI + S) with the same efficacy for mild-to-moderate asthma exacerbations. To date, no study has been done to evaluate emergency department (ED) length of stay (LOS) and opportunity cost between nebulized vs MDI + S. The objective of this study was to compare ED LOS and associated opportunity cost among children who present with a mild asthma exacerbation according to the delivery mode of albuterol: MDI + S vs NEB.
Methods:
A structured, retrospective cross-sectional study was conducted. Medical records were reviewed from children aged 1-18 years treated at an urban pediatric ED from July 2007 to June 2008 with a discharge diagnosis International Classification of Disease-9 of asthma. Length of stay was defined: time from initial triage until the time of the guardian signature on the discharge instructions. An operational definition was used to define a mild asthma exacerbation; those patients requiring only one standard weight based albuterol treatment. Emergency department throughput time points, demographic data, treatment course, and delivery method of albuterol were recorded.
Results:
Three hundred and four patients were analyzed: 94 in the MDI + S group and 209 in the NEB group. Mean age in years for the MDI + S group was 9.57 vs 5.07 for the NEB group (p < 0.001). The percentage of patients that received oral corticosteroids was 39.4% in the MDI + S group vs 61.7% in the NEB group (p < 0.001). There was no difference between groups in: race, insurance status, gender, or chest radiographs. The mean ED LOS for patients in the MDI + S group was 170 minutes compared to 205 minutes in the NEB group. On average, there was a 25.1 minute time savings per patient in ED treatment time (p < 0.001; 95% CI = 3.8-31.7). Significant predictors of outcome for treatment time were chest radiograph, steroids, and treatment mode. Opportunity cost analysis estimated a potential cost savings of $213,532 annually using MDI + S vs NEB.
Conclusion:
In mild asthma exacerbations, administering albuterol via MDI + S decreases ED treatment time when compared to administering nebulized albuterol. A metered dose inhaler with spacer utilization may enhance opportunity cost savings and decrease the left without being seen population with improved throughput.
Limitations:
The key limitations of this study include its retrospective design, the proxy non-standard definition of mild asthma exacerbation, and the opportunity cost calculation, which may over-estimate the value of ED time saved based on ED volume.</description><subject>Adolescent</subject><subject>Adrenergic beta-2 Receptor Agonists - administration & dosage</subject><subject>Albuterol - administration & dosage</subject><subject>Anti-asthmatic agents</subject><subject>Asthma</subject><subject>Asthma - drug therapy</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Economics</subject><subject>Emergency Service, Hospital</subject><subject>Female</subject><subject>Hospitals, Pediatric</subject><subject>Humans</subject><subject>Infant</subject><subject>Kentucky</subject><subject>Length of Stay - economics</subject><subject>Male</subject><subject>Medical Audit</subject><subject>Medication therapy management</subject><subject>Metered Dose Inhalers - economics</subject><subject>Quality of healthcare disease management</subject><subject>Regression Analysis</subject><subject>Retrospective Studies</subject><issn>1369-6998</issn><issn>1941-837X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kU1r3DAQhk1paUKaf1CKjr3sVh-2ZF9aSkibQqCXFnozY3m8q6CPrSRn8U_pv62cTQq9RAg0jJ55Z5i3qt4yuhWMsQ9MyE52XbvllPGtVHXTqhfVOetqtmmF-vWyxAXZrMxZdZnSHS1HCEYVe12dcV7TEsnz6s_1PdgZsvE7kvdILPpd3pMwkZRhIeBHsgK4ZrJxSIwnQA44GsjRaIIO4w69XsiIB4jZoc_kaIpEPgbiwog2kWEhOrjy_dCl5EczTRhXFOwwZ4zBlnpr7jEuJC0po0tvqlcT2ISXj-9F9fPL9Y-rm83t96_frj7fbrRQndp0jZ74VHMOemS8QU6lkCPtWC2As0a1rJYalJxwQNBKMN4yOjQU6kFqCUxcVO9PuocYfs-Ycu9M0mgteAxz6hnlRVeVW9D6hOoYUoo49YdoHMSlQP3qS__kS7_60p98KWXvHjvMg8PxX9GTCwX4dAKMn0J0cAzRjn3Zvw1xiuC1SUX--RYf_1PYI9i81xCxvwtz9GWBz8_4F7g3smQ</recordid><startdate>201208</startdate><enddate>201208</enddate><creator>Staggs, Lauren</creator><creator>Peek, Meagan</creator><creator>Southard, Gary</creator><creator>Gracely, Ed</creator><creator>Baxendale, Sidney</creator><creator>Cross, Keith P.</creator><creator>Kim, In K.</creator><general>Informa UK Ltd</general><general>Taylor & Francis</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201208</creationdate><title>Evaluating the length of stay and value of time in a pediatric emergency department with two models by comparing two different albuterol delivery systems</title><author>Staggs, Lauren ; Peek, Meagan ; Southard, Gary ; Gracely, Ed ; Baxendale, Sidney ; Cross, Keith P. ; Kim, In K.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3797-95cf2f422acd125e20636d09143a21578146ca76febeac7312810b50a4b6c6a13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Adolescent</topic><topic>Adrenergic beta-2 Receptor Agonists - administration & dosage</topic><topic>Albuterol - administration & dosage</topic><topic>Anti-asthmatic agents</topic><topic>Asthma</topic><topic>Asthma - drug therapy</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Economics</topic><topic>Emergency Service, Hospital</topic><topic>Female</topic><topic>Hospitals, Pediatric</topic><topic>Humans</topic><topic>Infant</topic><topic>Kentucky</topic><topic>Length of Stay - economics</topic><topic>Male</topic><topic>Medical Audit</topic><topic>Medication therapy management</topic><topic>Metered Dose Inhalers - economics</topic><topic>Quality of healthcare disease management</topic><topic>Regression Analysis</topic><topic>Retrospective Studies</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Staggs, Lauren</creatorcontrib><creatorcontrib>Peek, Meagan</creatorcontrib><creatorcontrib>Southard, Gary</creatorcontrib><creatorcontrib>Gracely, Ed</creatorcontrib><creatorcontrib>Baxendale, Sidney</creatorcontrib><creatorcontrib>Cross, Keith P.</creatorcontrib><creatorcontrib>Kim, In K.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of medical economics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Staggs, Lauren</au><au>Peek, Meagan</au><au>Southard, Gary</au><au>Gracely, Ed</au><au>Baxendale, Sidney</au><au>Cross, Keith P.</au><au>Kim, In K.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Evaluating the length of stay and value of time in a pediatric emergency department with two models by comparing two different albuterol delivery systems</atitle><jtitle>Journal of medical economics</jtitle><addtitle>J Med Econ</addtitle><date>2012-08</date><risdate>2012</risdate><volume>15</volume><issue>4</issue><spage>704</spage><epage>711</epage><pages>704-711</pages><issn>1369-6998</issn><eissn>1941-837X</eissn><abstract>Abstract
Objective:
Asthma is one of the most common childhood illnesses and accounts for a substantial amount of pediatric emergency department visits. Historically, acute exacerbations are treated with a beta agonist via nebulizer therapy (NEB). However, with the advent of the spacer, the medication can be delivered via a metered dose inhaler (MDI + S) with the same efficacy for mild-to-moderate asthma exacerbations. To date, no study has been done to evaluate emergency department (ED) length of stay (LOS) and opportunity cost between nebulized vs MDI + S. The objective of this study was to compare ED LOS and associated opportunity cost among children who present with a mild asthma exacerbation according to the delivery mode of albuterol: MDI + S vs NEB.
Methods:
A structured, retrospective cross-sectional study was conducted. Medical records were reviewed from children aged 1-18 years treated at an urban pediatric ED from July 2007 to June 2008 with a discharge diagnosis International Classification of Disease-9 of asthma. Length of stay was defined: time from initial triage until the time of the guardian signature on the discharge instructions. An operational definition was used to define a mild asthma exacerbation; those patients requiring only one standard weight based albuterol treatment. Emergency department throughput time points, demographic data, treatment course, and delivery method of albuterol were recorded.
Results:
Three hundred and four patients were analyzed: 94 in the MDI + S group and 209 in the NEB group. Mean age in years for the MDI + S group was 9.57 vs 5.07 for the NEB group (p < 0.001). The percentage of patients that received oral corticosteroids was 39.4% in the MDI + S group vs 61.7% in the NEB group (p < 0.001). There was no difference between groups in: race, insurance status, gender, or chest radiographs. The mean ED LOS for patients in the MDI + S group was 170 minutes compared to 205 minutes in the NEB group. On average, there was a 25.1 minute time savings per patient in ED treatment time (p < 0.001; 95% CI = 3.8-31.7). Significant predictors of outcome for treatment time were chest radiograph, steroids, and treatment mode. Opportunity cost analysis estimated a potential cost savings of $213,532 annually using MDI + S vs NEB.
Conclusion:
In mild asthma exacerbations, administering albuterol via MDI + S decreases ED treatment time when compared to administering nebulized albuterol. A metered dose inhaler with spacer utilization may enhance opportunity cost savings and decrease the left without being seen population with improved throughput.
Limitations:
The key limitations of this study include its retrospective design, the proxy non-standard definition of mild asthma exacerbation, and the opportunity cost calculation, which may over-estimate the value of ED time saved based on ED volume.</abstract><cop>England</cop><pub>Informa UK Ltd</pub><pmid>22400716</pmid><doi>10.3111/13696998.2012.674587</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adolescent Adrenergic beta-2 Receptor Agonists - administration & dosage Albuterol - administration & dosage Anti-asthmatic agents Asthma Asthma - drug therapy Child Child, Preschool Economics Emergency Service, Hospital Female Hospitals, Pediatric Humans Infant Kentucky Length of Stay - economics Male Medical Audit Medication therapy management Metered Dose Inhalers - economics Quality of healthcare disease management Regression Analysis Retrospective Studies |
| title | Evaluating the length of stay and value of time in a pediatric emergency department with two models by comparing two different albuterol delivery systems |
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