249
days
143
BREATHING INSTITUTE
THE RIGHT DIRECTION
A PARTNERSHIP WITH PUBLIC SCHOOLS BRINGS KIDS ASTHMA CARE
Students enrolled
in the program
saw an average
of 68% reduction
in asthma
exacerbations.
In a 30-student classroom anywhere
in America, about three kids are
likely to have asthma. The number
is even higher in socioeconomically
disadvantaged areas. Asthma
is a leading cause of school
absences and pediatric emergency
department visits around the
country, and most of them are
unnecessary, if given the right care.
“We saw an opportunity,” says
Stanley Szefler, M.D., Director of the
Pediatric Asthma Research Program
at Children's Hospital Colorado.
Ten years ago, Dr. Szefler and his
team partnered with Denver Public
Schools to conduct a survey of
DPS students and found 900 kids
with asthma. Fully, 46 percent of
those cases were not adequately
controlled.
Identifying those high-risk kids
was the first step in what eventually
became the Colorado Step Up
Asthma Program. A coordinated
effort between Children’s Colorado,
the Colorado Department of
Public Health and Environment,
a number of Denver Metro school
districts, and many other agencies,
the partnership has delivered
ongoing asthma education and
management to the kids and
families who need it most.
“We first figure out if the asthma is
controlled, says Dr. Szefler. “If there
are signs it’s not, like missed school
or ER visits, those signals get more
attention.” That attention comes
in the form of dedicated asthma
counselors who work with kids longterm to make sure they’re getting —
and correctly using — the right care.
Over the 2012–2013 school year,
students enrolled in the program
saw an average of 68 percent
decrease in asthma exacerbations
and a 58 percent reduction in
asthma-related absences totaling
more than five days.
STANLEY SZEFLER, M.D.
18
The program has worked so
well, Dr. Szefler’s team is now
collaborating with the American
Academy of Allergy, Asthma and
Immunology, and the National
Association of School Nurses to
potentially take the program, or
programs like it, nationwide.
days
BREATHING INSTITUTE
MAPPING THE
WAY HOME
BETTER VENTILATOR DISCHARGE LEADS
TO (MUCH) SHORTER HOSPITAL STAYS
2012
2015
43%
Hospital
length of
stay
A mannequin’s ventilator malfunctions. The oxygen level drops to 90
percent and keeps falling. A monitor frantically beeps. A discreet blue
LED light beneath the mannequin’s nose lights up and turns the lips blue.
Decision time: the parent needs to call 911, pull the vent, and start CPR.
The mannequin is a high-fidelity simulation of a patient, controlled by a
computer, that can blink, breathe, receive medical interventions, and even
simulate dying. The parent is the real-life parent of a real-life child who
requires a ventilator. After a long hospital stay, that child is getting ready
to go home. The mannequin helps prepare the parent for any emergency.
“Typically, simulation is used to train hospital staff,” says Christopher
Baker, M.D., Medical Director of the Ventilator Care Program at
Children’s Hospital Colorado. “We’re one of the few centers in the
country using it to teach families.”
Patients who require ventilators account for some of the lengthiest, most
expensive hospital stays — the average over 2011 and 2012 was 249 days,
Dr. Baker found. “And there were plenty of kids in the hospital for over a
year.” The Ventilator Care Program launched in 2013 with an ambitious goal:
to get kids on ventilators out of the hospital faster and, more importantly, safer.
Sending a child home with chronic ventilation involves staggering logistics:
training for parents and caregivers, coordination between multiple agencies,
and high-stakes decisions about the child’s stability. Dr. Baker and his team
applied a business technique called process mapping to standardize these
procedures, incorporating videos, handouts, and novel training (like the hi