Increasing the Use of Anti‐Inflammatory Agents for Acute Asthma in the Emergency Department: Experience with an Asthma Care Map

Background Little is known about the quality of acute asthma care in the emergency department (ED). Objectives We sought to determine the concordance of ED management of acute asthma with National Institutes of Health asthma guidelines, to identify ED characteristics predictive of higher guideline concordance, and to assess whether guideline concordance was associated with hospital admission. Methods We conducted a retrospective chart review study of acute asthma as part of the National Emergency Department Safety Study. Using a principal diagnosis of asthma, we identified ED visits for acute asthma in 63 urban EDs in 23 US states between 2003 and 2006. Concordance with guideline recommendations was evaluated by using item-by-item quality measures and composite concordance scores both at the patient and ED level. These scores ranged from 0 to 100, with 100 indicating perfect concordance. Results The cohort consisted of 4,053 subjects; their median age was 34 years, and 64% were women. The overall patient guideline concordance score was 67 (interquartile range, 63–83), and the ED concordance score was 71 (SD, 7). Multivariable analysis showed southern EDs were associated with lower ED concordance scores (β-coefficient, −8.2; 95% CI, −13.8 to −2.7) compared with northeastern EDs. After adjustment for the severity on ED presentation, patients who received all recommended treatments had a 46% reduction in the risk of hospital admission compared with others. Conclusions Concordance with treatment recommendations in the National Institutes of Health asthma guidelines was moderate. Significant variations in ED quality of asthma care were found, and geographic differences existed. Greater concordance with guideline-recommended treatments might reduce hospitalizations.

show abstract

“…35 Another ED-based program increased the systemic corticosteroid use from 57% to 68% through implementing an acute-care map. 36 …”

Section: Discussionmentioning

confidence: 99%

Quality of care for acute asthma in 63 US emergency departments

Tsai

Sullivan

Gordon

et al. 2009

Journal of Allergy and Clinical Immunology

View full text Add to dashboard Cite

show abstract

“…11 The prospective study presented here was designed to evaluate the influence of an abbreviated asthma care map (ACM) on the treatment of acute asthma in a single ED site. Specifically, the study compared asthma care delivery during 2 different time periods: prior to the implementation of an ACM and immediately post implementation during active promotion.…”

Section: Introductionmentioning

confidence: 99%

“…The implementation of this ACM in a tertiary care ED was recently documented. 11 This document was then edited to a shorter version based on feedback from a multidisciplinary group at the LRH working to develop a local solution to ED asthma care. Appendix 1 is a sample copy of the ACM.…”

mentioning

confidence: 99%

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

Mackey

Myles²,

Spooner

et al. 2007

CJEM

Self Cite

View full text Add to dashboard Cite

Introduction: Despite the frequency of acute asthma in the emergency department (ED) and the availability of guidelines, significant practice variation exists. Asthma care maps (ACMs) may standardize treatment. This study examined the use of an ACM to determine its effects on patient management in a regional hospital. Methods: Patients aged 2 to 65 years who presented to the ED with a primary diagnosis of acute asthma were enrolled in a prospective study that took place 5 months before (pre) and 5 months after (post) ACM implementation. Research assistants using a standardized questionnaire abstracted data through direct patient interviews and then followed up at 2 weeks with a standardized telephone interview. Results: Overall, 71 pre patients and 70 post patients were enrolled. Characteristics in both groups were similar. The care map was used in 100% of the cases during the post period. The mean length of stay in the ED for the pre, compared with the post period, was similar (2 h 14 min v. 2 h 25 min; p = 0.60), as were admission rates (11% v. 9%; p = 0.59). Systemic corticosteroid use was similar (62% v. 57%; p = 0.56); however, the total number of β-agonists (2 v. 4 treatments; p = 0.002) and anticholinergics (1 v. 2 treatments; p < 0.001) administered in the ED was higher during the post period. Prescriptions for oral (73% v. 60%; p = 0.15) and inhaled (78% v. 78%; p = 0.98) corticosteroids at discharge remained the same. Relapse rates at follow-up were unchanged (29% v. 34%; p = 0.52). Conclusion:This study provides evidence that implementation of an ACM increased acute bronchodilator use; however, prescribing preventive medications did not increase. Further research is required to evaluate other strategies to improve asthma care by emergency physicians.

show abstract

“… 28 Structured management plans and care maps for acute asthma have been shown to improve the use of objective measurements of airflow obstruction, increase the frequency of reevaluation and reassessment, and reduce admission rates and length of stay in both the ED and hospital. 29 , 30 Early response of FEV 1 or peak expiratory flow at 30–60 minutes after initial treatment is the best predictor of outcome. 31 , 32 …”

Section: Acute Potentially Fatal Asthmamentioning

confidence: 99%

Critical care in the ED: potentially fatal asthma and acute lung injury syndrome

Cardinal¹

2012

OAEM

View full text Add to dashboard Cite

Emergency department clinicians are frequently called upon to assess, diagnose, and stabilize patients who present with acute respiratory failure. This review describes a rapid initial approach to acute respiratory failure in adults, illustrated by two common examples: (1) an airway disease – acute potentially fatal asthma, and (2) a pulmonary parenchymal disease – acute lung injury/acute respiratory distress syndrome. As such patients are usually admitted to hospital, discussion will be focused on those initial management aspects most relevant to the emergency department clinician.

show abstract

Increasing the Use of Anti‐Inflammatory Agents for Acute Asthma in the Emergency Department: Experience with an Asthma Care Map

Abstract: The present study provides evidence that the standardized ED ACM was widely accepted, improved chart documentation, improved some aspects of ED care and increased prescribing of discharge preventive medications.

Cited by 12 publications

References 28 publications

Quality of care for acute asthma in 63 US emergency departments

Quality of care for acute asthma in 63 US emergency departments

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

Critical care in the ED: potentially fatal asthma and acute lung injury syndrome

Contact Info

Product

Resources

About