How commonly are children hospitalized for asthma eligible for care in alternative settings?

Objective: To estimate the proportion of children hospitalized for acute as thma exacerbation who might be cared for successfully in alternative settin gs such as shortstay units or in-home nursing. Design: Descriptive study based on analysis of hospital discharge files and on retrospective medical record review of a random sample of asthma hospit alizations. Methods: The 2028 asthma hospitalizations between 1991 and 1995 for childre n (aged <19 years) dwelling in Rochester, NY, were studied. Measures includ ed the duration of frequent administration of nebulized medication (2 or mo re times in a 4-hour period), worst oxygen saturation levels, deterioration , and hospital length of stay. Oxygen saturation values and nebulized medic ation frequency were determined by hospital record review on a random sampl e of 443 asthma episodes. Length of stay was available for all admissions. Results: Worst oxygen saturation following hospital admission was 95% or gr eater, 90% to 94%, and less than 90% for 21.3%, 51.6%, and 27.1% of episode s, respectively. Children received frequent nebulized medication treatments for a mean of 2.0 nursing shifts (8 hours per shift), although they remain ed hospitalized, on average, for 4.3 nursing shifts longer. Deterioration t o a critical level of severity was uncommon. Among children initially admit ted to the regular pediatric inpatient unit, only 0.7% subsequently deterio rated to the point that they were transferred to the critical care unit. Conclusion: More than 70% of asthma hospitalizations in this community coul d be cared for in alternative settings with supplemental oxygen, nebulized medication treatments, and close nursing observation provided, in most case s, for 2 nursing shifts.