AUTHOR BIOGRAPHIES
Jean De Asis, MAN, BSN, RN, BSBio, Nursing, Quality, Al Hada Armed Forces Hospital, Taif Region
Fawzyh AlKhadidi, MD, Pediatric Pulmonology, Armed Forces Hospital Taif Region
Fawzyh AlKhadidi is the regional Pediatric Department director at the Armed Forces Hospital Taif Region. She also serves as a pediatric pulmonary consultant and the head of the pediatric pulmonary subspecialty. Dr. AlKhadidi leads the quality improvement project featured in this publication, driving advancements in patient care and clinical outcomes.
Muhammad Hasan Abid, MD, MHQS, EMBA, Continuous Quality Improvement & Patient Safety, Armed Forces Hospital Taif Region Institute for Healthcare Improvement
Muhammad Hasan Abid is the regional head of Patient Experience & Continuous Quality Improvement and Patient Safety specialist physician at the Armed Forces Hospital Taif Region (AFHTR). He is also an Institute for Healthcare Improvement fellow, mentor, and subject matter expert. He provides leadership and strategic alignment of the quality improvement and patient safety projects with the strategic goals for patient experience at the AFHTR.
Turki AlOtaibi, MD, Pediatric , Armed Forces Hospital Taif Region
Turki AlOtaibi is a registrar physician at the Armed Forces Hospital Taif Region. He champions the EXHALE strategy in the general pediatric ward, contributing to improved patient care and outcomes.
Jamal Mousa Alnofeye, MBBS, EMBA, MHQS, Continuous Quality Improvement & Patient Safety, Armed Forces Hospital Taif Region
Jamal Mousa Alnofeye is a healthcare executive and quality leader with extensive experience in Saudi Arabia’s healthcare sector. As director of Quality and Patient Safety at Taif Military Hospitals, he drives strategic planning, accreditation, and patient safety initiatives. A board member of the Taif Health Cluster, he has also contributed to national healthcare policies. With degrees from Harvard Medical School and King Abdulaziz University, Alnofeye combines clinical expertise with strategic leadership, publishing research and leading quality improvements to enhance patient care.
Mohammed Althobaiti, MD, Pediatric, Armed Forces Hospital Taif Region
Mohammed Althobaiti is a registrar physician at the Armed Forces Hospital Taif Region. He champions the EXHALE strategy in the emergency department-pediatric zone, contributing to improved patient care and outcomes.
Abdulrahman AlHazmi, MD, Pediatric, Armed Forces Hospital Taif Region
Abdulrahman AlHazmi is a registrar physician at the Armed Forces Hospital Taif Region. He champions the EXHALE strategy in the Pediatric Outpatient Department, contributing to improved patient care and outcomes.
Hassan H. Althumali, MHA, Health Education, Armed Forces Hospital Taif Region
Hasan H. Althumali holds a diploma in respiratory therapy, as well as bachelor’s and master’s degrees in healthcare management. He currently serves as the regional director of Health Education at the Armed Forces Hospital Taif Region.
ABSTRACT
Globally, asthma causes a significant amount of morbidity and mortality among the pediatric population. Asthma affects about 25% of children in Saudi Arabia and is a common reason for emergency visits, with a significant social and financial burden. The EXHALE strategy, developed by the U.S. Centers for Disease Control and Prevention (CDC), offers a comprehensive approach to asthma management. Our project aimed to reduce pediatric asthma-related emergency department visits and hospital admissions by 20%.
Method
Our team developed a tailored approach at a tertiary hospital in Taif Region, Saudi Arabia, to meet the specific needs of our pediatric asthma patients as per the EXHALE strategy. The strategy consists of six components: education on asthma self-management, extinguishing smoking and exposure to secondhand smoke, home-based trigger reduction, achievement of guideline-based medical management, linkages and coordination of care across providers and settings, and encouragement of patients and engagement of healthcare practitioners. A pre- and post-design along with multiple Plan-Do-Check-Act cycles were used to implement this multifaceted approach, ensuring that young asthma patients receive the comprehensive support and resources needed to effectively manage their condition and enjoy an improved quality of life.
Results
There was a 60.61% reduction in the monthly average visits to the emergency department for asthma-related issues. The average monthly admission rate for asthma for pediatric population was reduced by 50%. The overall healthcare costs savings was 1,046,603 Saudi riyals during the project implementation from January to September 2023.
Conclusions
The EXHALE strategy is an effective approach to improve asthma care management while reducing the healthcare costs and improving the quality of life. This strategy also exemplifies a comprehensive and forward-thinking approach that aligns with both the specific goals of Saudi Vision 2030 and the broader mission of elevating healthcare standards.
Plain Language Summary
Asthma—a chronic inflammation of airways which causes wheezing, breathlessness, chest tightness, and coughing—is a serious health problem worldwide, including in Saudi Arabia, where it affects an estimated 25% of children. At the Armed Forces Hospital (AFH), a team observed that in 2022, 62% of its asthmatic patients were uncontrolled and accounted for 6% of monthly emergency department (ED) visits and 10% of monthly pediatric admissions. As part of Saudi Vision 2030, a kingdomwide initiative to improve the quality of life and well-being of citizens, AFH sought to reduce asthma-related ED visits and hospitalizations by 20% by the end of September 2023.
To accomplish their goals, the AFH team implemented EXHALE, a comprehensive approach to improving asthma care management developed by the U.S. Centers for Disease Control and Prevention (CDC) National Asthma Control Program. The team adapted the six strategies of EXHALE to pediatric asthma patients: (1) Education on asthma self-management, (2) eXtinguishing secondhand and thirdhand smoke, (3) Health education for trigger reduction and asthma self-management, (4) Achievement of guideline-based medical management, (5) Linkages and coordination of care across settings, and (6) Encouragement of patients and engagement of healthcare practitioners.
Their interventions resulted in a 60% reduction in ED visits and a 50% decrease in monthly admissions, and an increase in the percentage of controlled asthma patients from 38% to 72%. Savings in overall asthma management costs during the project implementation amounted to 1,046,603 Saudi riyals ($279,057).
