Care provided by Norton Children’s Pulmonology, affiliated with the UofL School of Medicine, helped Norton Children’s Hospital earn the No. 38 U.S. News & World Report ranking for pulmonology and lung surgery in 2022, aided in part by low pediatric asthma readmission rates.

The program has expanded its testing for asthma to help lower readmission rates and is innovative in using spirometry to determine discharge. Providers are in frequent communication with patients regarding follow-up appointments, and the multidisciplinary Norton Children’s Severe Asthma Clinic treats patients with severe forms of asthma.

“We have worked very hard to improve outcomes for our patients and thus elevate our national ranking,” said Scott G. Bickel, M.D., pediatric pulmonologist with Norton Children’s Pulmonology and medical director of respiratory therapy at Norton Children’s Hospital. “In addition, we have reported strong outcomes and improvements in our patients with cystic fibrosis, plus expanded participation in our multidisciplinary clinics.”

Objective discharge criteria result in 48% lower pediatric asthma readmission rates

Asthma is the leading cause of hospital admission in pediatric patients. Readmission of children with asthma is a serious issue, with recurrent hospitalizations estimated to account for 40% of all asthma admissions.

Data from Norton Children’s Pulmonology shows a considerably lower rate of pediatric asthma readmissions (87.5% reduction for seven-day readmissions, 48% reduction for 30-day readmissions) compared with national statistics. Although Norton Children’s patients have a slightly longer average length of stay (2.4 days compared with a national average of 1.5 days), its providers follow updated asthma treatment guidelines and strict, objective criteria for discharge.

This protocol strictly follows the National Heart, Lung, and Blood Institute Expert Panel Report asthma guidelines regarding management and discharge spirometry. Patients ages 6 years and older who are able perform spirometry do so when deemed clinically improved, and discharge is considered appropriate if their forced expiratory volume in one second (FEV1) is 70% of predicted or of their personal best.

Reducing pediatric asthma readmissions with a multidisciplinary approach

For patients, a multifaceted approach for family education and follow-up is used. A full-time asthma nurse educator ensures that all families have a written asthma care plan prior to discharge. The pulmonology service also works closely with the hospitalist group, intensivists and the emergency department to ensure high-risk patients have appropriate follow-up in a dedicated severe asthma clinic. The Norton Children’s Severe Asthma Clinic is staffed jointly by Adrian R. O’Hagan, M.D., pulmonologist with Norton Children’s Pulmonology, and Adriana S.  McCubbin, M.D., of Norton Children’s Allergy & Immunology, affiliated with the UofL School of Medicine.

The pulmonology team is expanding staffing to ensure its ability to provide care across multiple service lines, with goals that include continued strength of its fellowship program and bringing together multiple related specialties under one roof to foster collaboration and coordinated care.