Pediatric Asthma Treatment Center

All Sparrow asthma patients from 18 months to 18 years of age are automatically enrolled in the Asthma Treatment Center. The philosophy of the ATC is, "From the moment a patient hits our door, he (she) should be getting better."

The treatment of a pediatric asthma patient starts with aggressive care at the point of presentation (Emergency Department or direct admission from a physician's office). All patients receive a "pre-phase" (aggressive rescue treatment) within the first 60 minutes of presentation. A thorough respiratory assessment follows to determine if the patient meets discharge criteria.

Patients who are admitted are placed into one of three phases of illness–severe, moderate or mild–based on physical assessment and patient history. The program is designed to match treatment with severity of illness.

The ATC phases are time-limited and respiratory assessment-driven, based on a 13- point assessment by a Respiratory Therapist (RT). The assessment tool is used to evaluate and move the patient within the program, which is guided by the latest Evidence Based Medicine for the treatment of pediatric asthma.

Bronchiolitis

Many children who come to Sparrow Children's Center are diagnosed with bronchiolitis: swelling and mucus buildup in the smallest air passages in the lungs, often caused by a viral infection, making it difficult to breathe.

The Bronchiolitis Program was developed by Sparrow's Pediatric Program Management Group (Peds PMG) to improve patient care, encourage appropriate resource utilization and decrease Length of Stay (LOS).

The program standardizes and focuses on hydration, oxygenation, airway clearance, and frequent respiratory assessment. In a few cases, the use of other respiratory therapies is required.

The care of the patient starts with aggressive care at the point of presentation. A bronchodilator challenge determines whether the patient will benefit from that modality. The patient receives oxygen therapy and respiratory assessment consistent with their level of illness.

Head Trauma

• Falls are the most common cause of injury in children younger than 15
• Head trauma is the most common reason for admission to the hospital following an accident.
• CT scan has been the imaging tool of choice in evaluating the severity of head trauma in children and adults.

Approximately 120 pediatric patients are admitted to Sparrow each year with head injury. The majority of these injuries are mild. Until 2003, medical staff at Sparrow obtained a second CT scan of the head to look for potential "interval changes" before discharging a pediatric head trauma patient.

After reviewing all the repeat scans, we found that, in patients who were ready to be discharged based on physical examination, there were no new findings to change the decision to discharge.

Sparrow therefore eliminated the second CT scan in August of 2003 and began discharging patients based solely on clinical evaluation. This saves children exposure to radiation, extra time waiting for a test and the time required for the radiologist to read the study. So far we have not had to readmit any child who was discharged without a second CT.