Background

Limitations

Summary

Sample

Methods Data Collection & Outcomes/Measures

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

1.  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.

2.  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.

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

1.  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.

a)  Measured in minutes and seconds

2.  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.

3.  Additional analysis for missing data, will be conducted based upon how critical the missing

data is to the study.

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

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 to insure consistency

3.  Data cannot be generalized due to small non-randomized sample

size

4.  Can’t account for all of the nurses previous experiences and

training.

5.  One nurse may have 10 years of experience while another may

have only 2 years of experience. This can affect “usual care”.

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; 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 use the PAT

c.  Charge nurse will place a poster that signifies to use PAT, within the triage area during

week of PAT tool usage

2.  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 charting system for use of tool

b.  Hospitals with paper charting will use a triage form with PAT usage question

3.  At least twice per week, researcher visits 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.