UCSF Center for Healthcare Value - Caring Wisely 2.0

Crowd-sourcing innovative cost savings ideas from the front lines of care delivery systems

Eliminating or Reducing Albuterol Nebs in PUC and Asthma Clinic

[Submitted with Kimberlee Honda]

Albuterol is frequently given via nebulizer for treatment of acute asthma symptoms in both the Pediatric Urgent Care and Pediatric Asthma Clinic settings.

Administration of albuterol via nebulizer is significantly more costly than delivery via MDI, yet it has been established that delivery of albuterol via MDI is just as effective as nebulized treatment.  There may be specific patients for which nebulized treatments are indicated, but we are overutilizing nebulized treatments in both settings.  This reinforces a myth for parents that the asthmatic child with increasing symptoms requires a nebulizer at home.  As a result, parents often fail to understand proper MDI/spacer technique and will frequently request a nebulizer kit, along with additional Rx's for albuterol neb solution at home.  Eliminating or reducing the use of nebs in clinic could not only reduce overall hospital and pharmacy spending, but would help promote a consistent message for optimal use of MDI/spacer during acute or emergency situations at home.

For background/reference: http://www.sciencedirect.com/science/article/pii/S0736467908006665
A similar cost issue was addressed in the inpatient setting at UCSF through the "Nebs No More After 24" pilot: http://archinte.jamanetwork.com/article.aspx?articleID=1718442

For SFGH

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