A Pediatric Hospital-wide Asthma Severity Score (HASS): Reliability and
Effectiveness
Abstract
Background: Asthma is a leading cause of pediatric hospitalization in
the United States. Children hospitalized with asthma are often cared for
in different care settings during a single hospitalization. Our
objective was to study the reliability and safety of a new pediatric
hospital-wide asthma severity score (HASS) across different care units
within a single tertiary-care pediatric center. Methods. 150 patients
between the ages of 2 and 18 years hospitalized with a principal
diagnosis of status asthmaticus were included. Study patients were
followed from initial triage in the emergency department until the time
of medical readiness for discharge. Rates of medical errors, early
transfers to a higher level of care and medically indicated hospital
length of stay (LOS) were compared between 75 patients prior to and 75
patients after implementation of the HASS using retrospective chart
review. Inter-rater reliability was determined by collecting independent
HASS scores from blinded staff members after tandem or simultaneous
patient assessment. Results. Inter-rater reliability among untrained
staff members using the HASS was high. Rates of preventable adverse
events and medical errors were low and not significantly different
before and after implementation of the HASS. LOS was shorter after
implementation of the HASS but without statistical significance. Rates
of early transfer to a higher level of care were unchanged between study
years. Conclusion. The HASS is a reliable asthma severity tool that can
be used throughout hospitalization and also among multiple clinical
providers to trend clinical progress and optimize communication,
particularly during times of care handoffs.