Background: Acute asthma poses significant health burdens. Despite many standard guidelines, suboptimal management remained and has negative effect on the quality of care and outcomes.Objective: To evaluate the impact of the institutional care guideline for acute asthma in hospitalized children, focusing on treatment outcomes and medical expenses.Methods: This quality improvement retrospective cohort study involved children aged 1-15 years hospitalized due to acute asthma before and after the institutional acute asthma care guideline implementation during 2016-2024. The guideline consists of standard treatment protocol including stepwise use of bronchodilator and respiratory support as well as discharge planning. The guideline implemented using a Plan-Do-Study-Act (PDSA) cycle.Results: A total of 220 hospitalized acute asthma children were reviewed (69 pre- and 151 post-implementation group). After guideline implementation, there is a significant reduction in time to first in-hospital bronchodilator (117 vs 104 vs 70 mins, P < 0.001), also a significant increase in use of nebulized steroids (0 vs 27 vs 5, P < 0.01) and high flow nasal cannula (3 vs 24 vs 29, P < 0.001). For clinical outcomes, the 24-hour clinical respiratory score significantly improved after guideline implementation (1.06 point, P < 0.001). However, the increase in length of hospital stay (47.5 vs 65.6 h, P = 0.003) and total medical expenses (249.7 vs 460.6 vs 447.0 USD, P < 0.001) were observed in the post-implementation group.Conclusion: The developed acute asthma care guideline for hospitalized children can improve clinical outcomes faster, but cannot decrease hospital length of stay. The cost-effectiveness of the developed guideline required further evaluation.
