Miller Children’s & Women’s Hospital Long Beach became the first free-standing children’s hospital in California, and only the 11^th children’s hospital in the nation, to receive the Disease Specific Certification in Pediatric Asthma from The Joint Commission. This achievement denotes the highest honor for quality and excellence in patient care for children with asthma.

Miller Children’s underwent a site review on March 17, 2016. The Joint Commission reviewer evaluated compliance with national disease-specific care standards and pediatric asthma-specific requirements. Clinical practice guidelines and performance measures also were assessed.

“Asthma accounts for about half of the admissions to Miller Children’s,” says Steven Jensen, M.D., medical director, general pediatrics, Miller Children’s. “Knowing it affects such a large patient population, an analysis involving multiple disciplines, including physicians, nurses and respiratory care practitioners, was completed in 2013 to identify key areas of improvement. Out of the analysis, a project was launched aimed at creating an asthma care model of excellence.”

Evidence-based guidelines, including an asthma progression flow chart, were developed from an analysis of findings from the National Heart and Lung Institute and the Global Initiative for Asthma (GINA). Based on the patient’s condition, clinicians use the flow chart to determine which treatments to administer and the frequency of treatment. The chart also identifies when care should be escalated, such as an admission from the emergency department to an inpatient unit.

Using a tool called a clinical respiratory score, the patient’s condition is based on four markers, including respiratory rate, work of breathing, shortness of breath and wheezing on a lung exam.

“Our goal was to reduce the variation in clinical processes and the risk of error,” says Eliezer Nussbaum, M.D., chief of staff and medical director, Pediatric Pulmonary Center, Miller Children’s. “To achieve that, we standardized the way asthma care is provided throughout Miller Children’s, including the emergency department, general pediatric units, including a dedicated pediatric pulmonary wing, pediatric intensive care unit, outpatient specialty centers and even in the child’s home.”

Mirroring the flow chart, families are given a “roadmap to health” explaining what they might experience in the different medical areas. Research has shown that educating families on their child’s condition reduces readmissions to the hospital.

To ensure proper asthma management at home, a comprehensive asthma curriculum for patient and families was developed.

“An assessment is conducted upon admission to determine the educational needs of the patient and family,” says Maila Dumaup, director, respiratory care services, Miller Children’s. “From there, a customized education plan is developed and teaching begins immediately upon admission. If patients are referred to our outpatient specialty center, they continue to receive education at follow-up visits.”

Before discharge, each patient is given an individualized “asthma action plan.” Depending on the severity of their symptoms, there are specific instructions that range from taking medications to calling 911.

“We have created a model for asthma care that ensures the best outcomes for patients and families no matter where they are,” says Suzie Reinsvold, chief operating officer, Miller Children’s. “This outstanding achievement could not have come without the help of a dedicated, multi-disciplinary team of leaders.”