Continuous Aerosolized Albuterol Treatment for Status Asthmaticus on the General Care Floor: A Quality Improvement Initiative.

Abstract

Introduction: Asthma, a leading cause of pediatric hospitalization, affects more than 6 million US children and costs more than $5 billion annually. Continuous aerosolized albuterol (CAA) effectively treats severe exacerbations but is typically reserved for intensive care or emergency settings. This quality improvement project aimed to safely expand CAA use on the general care floor (GCF) by monitoring treatment uptake, protocol adherence, and safety outcomes.

Methods: This single-center quality improvement project, led by a multidisciplinary team, included children aged 2-18 years with status asthmaticus on CAA who met the inclusion criteria. Interventions involved protocol development, staff education, electronic health record updates, and a resident-led handoff huddle. Primary outcomes were non-pediatric intensive care unit (PICU) CAA hours and the proportion of patients treated on the GCF. Process measures included protocol use and handoff huddles. Balancing metrics included PICU and emergency transfers, fluid-refractory hypotension, and ED length of stay.

Results: From June 2024 to October 2025, GCF CAA accounted for 17% of total hospital CAA, surpassing the 10% target. ED length of stay remained unchanged, indicating no disruption to workflow. We safely treated 72 patients on the GCF (average CAA duration of 21.6 h); 22 (31%) required PICU transfer; none were emergent transfer. This intervention saved 1,017 PICU hours (42.4 PICU bed-days), equivalent to $275,600 in room-and-board costs. These savings represent a substantial reduction in PICU resource use; however, we did not conduct a formal cost-effectiveness analysis.

Conclusions: CAA can be safely administered in the GCF following a structured protocol, reducing the need for PICU resources without adversely affecting ED care efficiency.