Compliance with guidelines for emergency management of asthma in adults: experience at a tertiary care teaching hospital

Abstract

Objectives: Despite evidence-based clinical practice guidelines for the emergency management of asthma, substantial treatment variation exists. Our objective was to assess compliance with the Canadian Association of Emergency Physicians (CAEP) / Canadian Thoracic Society (CTS) Asthma Advisory Committee's "Guidelines for the emergency management of asthma in adults" in the emergency department (ED) of a university-affiliated tertiary care teaching hospital. Methods: This retrospective study was conducted in a Canadian inner city adult ED. Investigators reviewed all ED records for the period from Jan. 1, 20011, , to Dec. 31, 2001, and identified adult patients (i.e., >18 years of age) with a primary ED diagnosis of asthma. Hospital records were then reviewed to document compliance with the CAEP/CTS asthma guidelines. Descriptive statistics, including means, standard deviations and frequencies were used to summarize information. Results: Overall compliance with the guidelines was 69.6%, (95% confidence interval, 64.7%-74.5%), but compliance ranged from 41.4% for severe asthma, 67.1% for moderate asthma, and 88.6% for mild asthma. Interobserver reliability for compliance assessment was excellent. Conclusions: Despite publication and dissemination of evidence-based guidelines for the management of acute asthma in adults, guideline compliance at a university-affiliated, inner city, tertiary care teaching hospital ED is suboptimal.

Changing the process of care and practice in acute asthma in the emergency department: experience with an asthma care map in a regional hospital

“…Overall, we were disappointed with the failure to improve practice with anti-inflammatory agents. One observation that is germane to this discussion is that the use of inhaled corticosteroids was already higher than reported elsewhere in Canada 14,29 and interventions to improve practice are most effective where treatment adherence is low. 30 ACM development did incorporate evidence-based approaches and resulted in input from a multi-disciplinary, "bottom-up" team including generalist and specialist clinicians.…”

“…28 Despite a multifaceted approach in the development and dissemination, which conforms with current knowl- edge about effective methods of changing practice, 29 the ACM improved process more than it improved care. Moreover, the improvements in care were observed in the areas of supportive and symptomatic care (bronchodilation, in-ED care) rather than preventive care (anti-inflammatory, discharge care).…”

Intravenous Ketamine in a Dissociating Dose as a Temporizing Measure to Avoid Mechanical Ventilation in Adult Patient with Severe Asthma Exacerbation

“…Studies have shown an increase in prevalence and severity of asthma during the last 20 years despite publication and dissemination of evidence-based guidelines for the management of acute and chronic asthma (1)(2)(3)(4)(5). Patients experiencing severe asthma exacerbation occasionally deteriorate to respiratory failure and require mechanical ventilation.…”

Improving adherence to asthma clinical guidelines and discharge documentation from emergency departments: Implementation of a dynamic and integrated electronic decision support system†

“…Current evidence suggests that asthma management in ED remains inconsistent 16,17 . This is reflected in suboptimal documentation and compliance with current asthma guidelines 18,19 . Implementation of information technology systems is seen as a potential solution to standardization, quality control and translational research in medicine.…”