Expertise in Pediatric Pulmonary and Sleep Medicine
Special Program Callouts
Arkansas Children’s Asthma Clinical and Research Program
The ACH Asthma Program is a joint venture between the Allergy & Immunology and Pulmonology Sections at UAMS.
The Arkansas Children’s Asthma Clinical and Research Program was established with goals to improve adherence to current national best practice standards for asthma care and utilize lessons learned to expand the adoption of current national best practice standards in pediatric asthma care to statewide pediatricians through the Arkansas Children’s Care Network (ACCN).
Clinical Milestones
- Management/revision of the acute asthma pathway (ACH/ACNW)
- Scheduling >90% of inpatient asthmatics for a follow-up visit within 30 days of discharge with > 70% attendance.
- Scheduling nearly 70% of emergency department (ED) asthmatics for a follow-up visit within 30 days of discharge with > 60% attendance.
- Before this process, < 30% of inpatients were scheduled for follow-up, and there was no process for follow-up of ED asthmatics.
- Creating and implementing an acute asthma outcomes dashboard, allowing for real-time tracking of acute asthma metrics (LOS, cost, admission rates, etc.)
- Development of an outpatient primary care asthma pathway for use by ACCN partners.
- Formalized ACH specialty clinic referral process.
- Creation and implementation of a Severe Asthma Clinic, including multispecialty: Allergy, Pulmonary, Social Work, Respiratory Therapy, and Clinical Psychology, providing three ½ clinics per month (5-6 patients/clinic).
Education Milestones
- Creation of education strategies for Asthma Providers Program (ESAP)
- Implemented education curriculum with multiple learning styles for Respiratory Therapists.
- Creation of an interactive, acute asthma management program for new Pediatric interns.
- Implemented branded and health literacy vetted education resources for families across the Arkansas Children’s System.
- Increase in number of certified asthma educators.
- Consistently develop education and deliver presentations for a variety of learners.
- School Nurse Academy (2018-2019)
- Creation of emergency-use albuterol action plans for use in schools across Arkansas, with support from the Arkansas Chapter of the AAP, AAFP, and Arkansas Medical Society.
- Grant funding by Blue and You Foundation.
- $150,000 in total funding.
- Provided materials, resources, and albuterol to school nurses.
Research Milestones
Quality Improvement
- Acute asthma: delayed time from admission to initial assessment by RT Coordinator
- QI project led to a 45% decrease in time to initial RT Coordinator evaluation (157.6 minutes to 86.3 minutes).
- Lost inhalers – inpatient asthmatics are discharged with inhalers – over 60 inhalers are left behind, leading to increased cost and safety trackers.
- QI project to put lock boxes in each inpatient room created a reduction in safety tracker and cost savings of $27,000 annually.
Research
- Creation of a severe asthma registry – Over 50 patients enrolled to date.
- Research abstracts accepted to AAAAI and ATS.
- Home Assessment Pilot study
- Awarded grant funding by UAMS-TRI.
- Assess the utility of telemedicine in performing home assessments for identification/reduction of asthma triggers.
- Completed: 2022
- Severe Asthma Consortium – Joined 2022 – partnership with other Pediatric severe asthma programs across the US.
Severe Asthma Clinic
The SAC focuses on the subset of children who are classified as having severe persistent or difficult-to-treat asthma. These patients are at high risk of life-threatening exacerbations of their asthma and often experience frequent healthcare utilizations. Although these children make up less than 5% of the overall asthma population, severe asthmatics account for over 50% of asthma-related healthcare expenditures. Given the variety and complexity of factors that drive severe asthma, a multidisciplinary clinic model is utilized with resources from Allergy, Pulmonary, Respiratory Therapy, Social Work, and Clinical Psychology.
Multidisciplinary Centers
Several multidisciplinary centers involving Pulmonology at ACH bring tremendous potential benefits for families, patients, quality of care, education, and research.
Arkansas Children’s Cystic Fibrosis Center
The Arkansas Children’s Cystic Fibrosis Center serves as the only CF Center in Arkansas, following patients in two locations: the main campus in Little Rock at ACH and Springdale at ACNW.
Our CF Center is accredited by the National CF Foundation (CFF). Our center follows national practice guidelines and provides high-quality, specialized CF care. Besides caring for people with CF, our center participates in CF clinical research and is part of the CFF Therapeutic Development Network. The CF center at ACH also trains future doctors, nurses, and healthcare workers about CF. Currently, around 160 children with CF receive regular care at ACH. Our young adults are transitioned to an adult CF care center around the time of high school graduation. The University of Arkansas for Medical Sciences (UAMS) is the only adult CF Care center in the state accredited by the CFF. Both centers work closely to deliver quality care to people living with CF in Arkansas.
Arkansas Children’s Primary Ciliary Dyskinesia Center
The ACH PCD Center is the only tertiary center in the state of Arkansas. Primary Ciliary Dyskinesia (PCD) is a rare disease that damages the cilia. It affects approximately 1 in every 10,000 to 30,000 people. Some people are born with problems with the cilia that prevent them from moving the mucus out of the airways. This can cause mucus to build up and lead to breathing problems and infections. PCD affects mainly the sinuses, ears, and lungs. Some people who have PCD have breathing problems from the moment of birth.
PCD can only be diagnosed by advanced early diagnostic skills and specialized testing, available only at ACH in this state. Arkansas Children’s is now a member of the growing PCD Foundation Clinical and Research Centers Network (PCDF-CRCN).
Multidisciplinary Clinics
Several multidisciplinary clinics involving Pulmonology at ACH bring tremendous potential benefits for families, patients, quality of care, education, and research.
Sickle Cell Clinic
The Sickle Cell Clinic aims to provide care for patients with pulmonary manifestations of sickle cell in a multidisciplinary clinic to make it easier for patients/families and centralize their care. More productive clinical discussions are had when Pulmonary and Hematology are in the same clinic. This proximity provides invaluable collaborative care opportunities.
Fontan Clinic
Children with Fontan physiology are at risk for liver fibrosis, protein-losing enteropathy, plastic bronchitis, sleep-disordered breathing, both restrictive and obstructive lung disease, and neurocognitive impairments, in addition to cardiac morbidities such as heart failure and arrhythmias. Fontan physiology patients were not routinely screened for these pulmonary diseases. Routine screening now includes blood work, sleep studies if indicated, and pulmonary function tests (PFT) to assess pulmonary and liver function, in addition to basic and advanced imaging. Many of these patients drive 2-4 hours to clinic, and seeing them together with Cardiology has numerous advantages for the families and their medical care
Spinal Muscular Atrophy (SMA) Clinic
The SMA Clinic provides excellent family-centered care for children with SMA. Spinal muscular atrophy is a genetic, progressive disease that affects the part of the nervous system that controls voluntary muscle movement. SMA is a motor neuron disease and involves the loss of nerve cells, called motor neurons, in the spinal cord. Patients with SMA have some degree of chronic respiratory failure, and many are ventilator-dependent, with other respiratory morbidities.
Multidisciplinary Dystrophinopathies Clinic
The Multidisciplinary Dystrophinopathies Clinic provides comprehensive, multidisciplinary care for patients with muscular dystrophy and similar disorders. The clinic aims to maintain the highest standards in clinical and subspecialty services, rapidly apply new evidence-based knowledge, and comply with standards in clinical care. Pulmonologists provide input concerning airway clearance, ventilation needs, polysomnography, and PFT monitoring. Many patients come from surrounding states of Mississippi, Tennessee, and Missouri.
Other benefits:
- Standardizing care of children in PICU who come with respiratory failure due to viral illness and pneumonia has helped in decreasing morbidity and length of stay.
- Developed Arkansas DMD registry for patients with DMD and looking at improving clinical outcomes.
- Currently participating in clinical trials for DMD patients.
- The Collaborative is actively involved in multiple QI projects and research.
Pediatric Pulmonary Hypertension Clinic
The Pulmonary Hypertension Clinic at Arkansas Children’s provides specialized care for patients experiencing problems with pulmonary hypertension. This clinic draws children from other states, including Texas, Missouri, Mississippi, and Tennessee. This coordinated effort with Pediatric Cardiology has helped streamline the medical management of patients in inpatient and outpatient settings.
Aerodigestive Clinic
The Aerodigestive Clinic aims to treat a wide variety of complex aerodigestive problems in a multidisciplinary fashion. This clinic attempts to meet this need through a collaborative effort between pulmonology, otolaryngology, gastroenterology, and speech pathology. The clinic is strongly promoted at ACH as an essential offering for patient care.
Craniofacial Clinic
The clinic is comprised of a multidisciplinary team, including plastic surgery, ENT, sleep medicine, genetics, nutrition, speech therapy, audiology, dentistry, orthodontics, and psychology. The clinic treats mostly pediatric patients and some adults with craniomaxillofacial abnormalities, such as Pierre-Robin sequence, Treacher Collins, craniosynostosis, and more. It is a clinic that coordinates care on the same day with all these different specialties to help address multiple issues in a convenient fashion for families. There is a conference after the clinic for all the specialties to discuss each patient and coordinate their care.