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Saturday 01 March 2003

Outcome evaluation of early discharge from hospital with asthma.

By: Khan SR, Henry RL, Hurst T.

Respirology 2003 Mar;8(1):77-81

OBJECTIVE: The aim of the study was to determine whether it was safe to discharge children with asthma from hospital when stable on 3-hourly rather than 4-hourly doses of salbutamol. METHODOLOGY: A retrospective study of 419 individual admissions of 359 children with asthma was undertaken. We defined a theoretical 'time ready for discharge' (TRD) for asthmatic admissions based on: (i) at least two doses of 3-hourly salbutamol and due for the third dose, (ii) no oxygen supplementation, (iii) no intravenous fluid or therapy, and (iv) time of discharge should be either before 17:30 hours or after 07:30 hours. Each admission was analysed using appropriate parameters to assess for risks and benefits of using this theoretical TRD as a guide for discharging asthmatic children from hospital. RESULTS: A total of 116 (27.7%) children were discharged before our theoretical TRD, including 11 children who received salbutamol no less often than 2-hourly and 37 who had a single dose of 3-hourly salbutamol before discharge. Re-admission to hospital and representation to the Emergency Department without re-admission within 1 week of discharge were less common in the group who were discharged before they had achieved theoretical TRD than in those who were discharged at or after the theoretical TRD, although the numbers were too small to reach statistical significance. Between our theoretical TRD and actual time of discharge two children who received supplemental oxygen and more frequent salbutamol may have required re-admission. CONCLUSIONS: From the medical viewpoint discharge when the child is stable on 3-hourly rather than 4-hourly doses appears safe. This can be expected to shorten length of stay by an average of 5.5 h (P < 0.001).

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